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Stress, Anxiety, and Coping in a Live SupervisedIndividual Counseling Practicum: a GroundedTheoryErnest George Zullo III

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Recommended CitationZullo, Ernest George III, "Stress, Anxiety, and Coping in a Live Supervised Individual Counseling Practicum: a Grounded Theory"(2015). Dissertations. Paper 315.

© 2015

ERNEST GEORGE ZULLO III

ALL RIGHTS RESERVED

UNIVERSITY OF NORTHERN COLORADO

Greeley, Colorado

The Graduate School

STRESS, ANXIETY, AND COPING IN A LIVE SUPERVISED

INDIVIDUAL COUNSELING PRACTICUM:

A GROUNDED THEORY

A Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Ernest George Zullo III

College of Educational and Behavioral Sciences

School of Applied Psychology and Counselor Education

Counselor Education and Supervision

August 2015

This Dissertation by: Ernest George Zullo III

Entitled: Stress, Anxiety, and Coping in a Live Supervised Individual Counseling

Practicum: A Grounded Theory Study

has been approved as meeting the requirement for the Degree of Doctor of Philosophy in

College of Educational and Behavioral Sciences in School of Applied Psychology and

Counselor Education, Program of Counselor Education and Supervision

Accepted by the Doctoral Committee

Linda L. Black, Ed.D., Research Advisor

Heather M. Helm, PhD, LPC, RPT/S, Committee Member

Jennifer Murdock, PhD, LPC, Committee Member

William D. Woody, PhD, Faculty Representative

Date of Dissertation Defense

Accepted by the Graduate School

Linda L. Black, Ed.D.

Dean of the Graduate School and International Admissions

iii

ABSTRACT

Zullo, Ernest George. Stress, Anxiety, and Coping in a Live Supervised Individual

Counseling Practicum: A Grounded Theory Study. Published Doctor of

Philosophy dissertation, University of Northern Colorado, 2015.

This study represents the initial attempt to create an emergent theory of how

counseling students cope with the stress and anxiety inherent in a live supervised

individual practicum from CACREP accredited training programs. This research

followed the qualitative research traditions surrounding emergent theory creation and

involved nine participant masters’ students throughout the entire practicum semester.

This study found 16 themes separated into three categories. Sources of anxiety:

(a) anticipatory anxiety and fear, (b) meeting obligations outside of practicum, (c)

interpersonal conflicts, (d) the live supervision environment, and (e) feedback. Modifiers

and influencers of stress and anxiety: (a) practicum social environment, (b) need for

perfectionism, (c) trait anxiety, and (d) previous experiences. Coping strategies used by

students: (a) support, (b) effective supervision, (c) positive attitude change, (d) self-care

interventions, (e) blaming, (f) catharsis, and (g) foreclosure or no coping.

The emergent theory consists of six coping dimensions that every practicum

student must navigate. Each of the dimensions are anchored and defined by a continuum

of coping effectiveness: poor, moderate, and excellent. The six coping dimensions are:

(a) personal characteristics, (b) interpersonal characteristics, (c) group interactions, (d)

emotions, (e) cognitions, and (f) use and understanding of coping skills. The final

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component of the emergent theory are three coping trajectories that help to explain

individual student's pathways throughout the practicum semester, with regard to the

coping dimensions. These coping trajectories are: effective, inconsistently effective, and

ineffective.

Recommendations for counselor educators and supervisors include creating a

formal student self-care plan, the addition of a pre-practicum skills class, and group stress

relieving activities for students.

Key words: Anxiety, Stress, Coping, Live Supervision, Counseling Students, Counselor

Education, and Emergent Theory.

v

ACKNOWLEDGEMENTS

First and foremost, I would like to express my deepest gratitude to Dr. Linda

Black. Without Dr. Black's encouragement and support this dissertation, and probably my

entire doctoral education, would not have been possible. Dr. Black has supported me

through the good times and the very bad times and I am deeply indebted to her. I know I

can repay that debt by striving to be the counselor educator she has demonstrated with me

throughout the years. I would like to dedicate this dissertation to her.

I would also like to thank my mother, Cathy Zullo, who has stood by me through

this entire chapter in my life and without which this dissertation would also not have been

possible. I love you mom. I am a very lucky person to have been blessed with a mother

who has also become a rock upon which I can lean and receive unwavering support from.

To my sister, Mary Catherine Zullo-Putt, I love and appreciate your humor and support

through writing my little paper. To my nephew, Jack Allan Putt, I love you kiddo and I

regret missing weekends and special events with you because I needed to work on,

"school stuff again," as you put it. My hope Jack is the part of my life where I miss the

important things in your life is over.

To my doctoral committee, Dr. Heather Helm, Dr. Jennifer Murdock, and Dr.

Doug Woody. I have been blessed to have you on my committee and to have had your

undying support and help throughout my education and dissertation. To Dr. Heather

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Helm, you have taught me that I can be firm and also be kind and gentle. I have been in

awe of your abilities as a counselor educator. To Dr. Jennifer Murdock, when things in

my doctoral program were flipped upside down, you were the only one who asked me

what I wanted to do. I appreciated so much that I felt like you were always on my side.

To Dr. Doug Woody, who started this whole adventure many years ago. Dr. Woody, you

saw potential in a goofy psychology student that even I didn't see. You believed that I

could be more than a bartender from Texas, when I didn't. Without you Dr. Woody, none

of my academic accomplishments would have been possible. Thank you all.

Finally, I would like to thank my good friend, Dr. Danielle O'Malley, who put up

with me badgering her at all times of the day with a million little questions. Quite a few

times Dani, we were in the same place in our education and I appreciate your humor and

support. Especially when I was frustrated with the dissertation that wouldn't die.

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TABLE OF CONTENTS

CHAPTER I. INTRODUCTION 1

The Story of Mary 1

Model of Counselor Development 3

Student Perceptions of Stress in Practicum 5

Coping 6

Statement of the Problem 8

Rationale for the Study 10

Significance of the Study 11

Guiding Objectives and Questions 12

Delimitations 12

Definition of Terms 13

CHAPTER II. LITERATURE REVIEW 16

Counselor Training Context 16

Characteristics of Adult learners 17

Adult Learning 19

Counselor Development 22

Anxiety in Practicum 30

Appraisal Model of Stress and Coping 36

CHAPTER III. METHODOLOGY 45

Epistemology 46

Grounded Theory 46

Participants 47

Sources of Data 49

Epoche 50

Data Analysis 52

Ethical Considerations 53

Trustworthiness 53

Authenticity 56

CHAPTER IV. RESULTS 58

Sources of Anxiety 64

Modifiers and Influencers of Anxiety 72

Coping Strategies 77

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CHAPTER V. DISSCUSSION AND RECOMMENDATIONS 87

Anxiety and Stress 87

The Context of Anxiety and Stress 98

Coping 103

An Emergent Theory of Anxiety, Stress, and Coping 108

Limitations of the Study 118

Areas for Future Research 119

Implications 120

REFERENCES 123

APPENDIX A. INSTITUTIONAL REVIEW BOARD APPROVAL 141

APPENDIX B. INFORMED CONSENT (ORIGINAL) 143

APPENDIX C. INFORMED CONSENT (MODIFIED) 145

APPENDIX D. DEMOGRAPHIC QUESTIONAIRE 147

APPENDIX E. INITIAL INTERVIEW QUESTION GUIDE 149

APPENDIX F. FOUR GUIDED JOURNAL PROMPTS 151

APPENDIX G. FINAL INTERVIEW QUESTION GUIDE 153

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LIST OF TABLES

Table 1

Stress Appraisals Based on Different Influences 42

Table 2

Categories, Themes, and Elements of the Current Study 64

x

LIST OF FIGURES

Figure 1

The appraisal model of stress and coping 38

Figure 2

Research Plan Schedule 50

1

CHAPTER I

INTRODUCTION

No pressure, no diamonds.

-- Robert Carlyle

The story of Mary:

I'm terrified to walk into that room again. I want to be a counselor so badly, but it

seems like it's all slipping away. I feel a lump in my throat as I leave the classroom with

my classmates and the professor. As we approach the counseling rooms I feel like I'm

about to burst into tears. I’m not sure I can face my client today because I am worried

about failing practicum. I walk into the dark observation room and place the video disk in

the recorder. I know I have to review this session later, but I just don’t want to see myself

again stumbling and fumbling. I look through the one-way mirror into the counseling

room and feel a whole new wave of panic. I know my client is in the waiting room. As I

get up to leave, a few of my peers offer encouragement, “You can do this," and another

whispers in support, "You're going to be great." I don't believe either one of them, they're

not telling me the truth; they just feel sorry for me and don’t want me to cry.

As my session begins fear and panic rise up in me. At times, I am not sure what

my client said, because I was so distracted by my self-talk or thought I could hear my

peers’ comments behind the glass. Once the session was over a sense of Dread

overwhelmed me as I anticipated my peers’ feedback and how I had to sit through their

feedback. It's difficult to hear or understand anything others are saying to me except that

I’ve screwed up, just like I knew I would. My eyes well up with tears; thankfully

2

feedback was brief because we needed to reset for the next client. My peers wrote down

their feedback; I hope to read it when I am alone.

The previous vignette presents a composite of some of the personal and

professional experiences some students encounter during a live supervised practicum;

experiences that are both common and unique and which likely exist on a continuum

ranging from progressive (e.g., growth producing) at one end to regressive (e.g., growth

restricting) at the other. For students like Mary to develop into effective mental health

counselors they need to understand the process and address the dynamic interplay

between her anxiety and coping responses and how they impact her learning (Bandura,

1956). Should students fail to do this, they are likely to be less effective with their clients

and may experience frustration or concern related to their education and training

(Cowden, 2010).

There exists a real need in our society for well-trained mental health counselors

(Honberg, Kimball, Diehl, Usher, & Fitzpatrick, 2011). The National Institute for Mental

health (NIMH, 2013) reported in 2008, 27.9 million people in the U.S. adult population

utilized mental health services; a number that increases each year (NIMH, 2003.) At the

entry level, most counselor-in-training (CITs), engage their first clients during their

practicum experience; where they are expected to systematically integrate and apply their

theoretical knowledge, skills and personal dispositions. Much like the Carlyle quote that

opened this chapter, the counseling practicum can be a time of great pressure, stress and

anxiety which ultimately provides the pressure to produce ‘diamonds’ from rough

material. To complete this metaphor, counselor educators create the environment in

which the ‘pressure’ is experienced as students’ high standards, quality support, and the

3

opportunity to grow personally and professionally (Association for Counselor Education

and Supervision, 2011).

Most counseling students come to their graduate education as adults (Schweiger,

Henderson, Clawson, Collins, & Nuckolls, 2008). Thus, their experience and needs differ

from those of undergraduates and are focused on meaning making, real world application,

and the integration of previous experiences (Knowles, Holton, & Swanson, 2011;

Mezirow, 1996). Additionally, graduate students who train in the area of counseling are

believed, by some, to progress through a stage developmental process from novice

counselor to a pre-licensure status during their initial formal training period (Loganbill,

Hardy & Delworth, 1982; Stoltenberg & McNeill, 2010; Ronnestad & Skovholt, 2003).

Model of Counselor Development

Several theories of counselor development exist in the professional literature. For

the purposes of this study, I utilize the Integrated Developmental Model (IDM) of

counselor development and clinical supervision (Stoltenberg & McNeill, 2010) because it

is the most empirically supported model available as noted by Bernard and Goodyear,

2014, "… IDM is the best known and most widely used stage development model of

supervision. It has the virtue of being both descriptive with respect to supervisee

processes and prescriptive with respect to supervisor interventions" (p. 34). The

Integrated Developmental Model has four distinct levels of counselor developing.

Because this study is focused on counselors during their formal graduate training only the

first two will be articulated for the reader (Stoltenberg & McNeill, 2010). Level one of

IDM is described as a time when the student demonstrates high motivation, experiences

high levels of stress, and engages in dichotomous thinking. Level two is described as a

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time when student's often experience wild fluctuations in motivation and confidence.

Levels one and two of IDM are believed to be experienced by a student during the typical

15-17 weeks of a university semester or time frame of a counseling practicum

(Stoltenberg & McNeill, 2010) which is also the time frame of inquiry for the present

study.

The transition from Level one of IDM to Level two can be difficult for the student

as his or her sense of equilibrium and confidence in his or her abilities are challenged by

the increasing complexities of the counseling and supervision processes as well as his or

her fear and desire for autonomy. Stoltenberg and McNeil (2010) described this transition

as a time when the supervisor must "shake the tree" (p. 80) of the supervisee by assigning

them to increasingly more difficult and complex clients. Stoltenberg and McNeil (2010)

wrote:

The Level 2 therapist is making a transition across the various domains

from dependence on the supervisor to a sense of more independent

functioning, from primarily a self-focus to more of a focus on the client

experience, and from a previously high and fairly stable level of

motivation to more fluctuating levels. Unless this transition is successfully

negotiated, this period can be a difficult, conflictual time for supervisee

and supervisor alike, characterized by disruption, resistance, ambivalence,

and instability (p. 83).

This conflictual time can be a great source of anxiety for the practicum student. Too

much anxiety can lead to higher levels of frustration and may inhibit their growth during

this critical time in practicum (Stoltenberg & McNeill, 2010). It is no wonder then that

many beginning counseling students in practicum cite the facilitative and supportive

behaviors of their supervisors as the most important during this transition period between

levels (Heppner & Roehlke, 1984).

5

Student Perceptions of Stress in Practicum

The literature and research on students’ perceptions of practicum have focused

mostly on students’ perceptions of the supervision experience (Daniels & Larson, 2001;

Gnika, Chang, & Dew, 2012; Hendrickson, Veach, & LeRoy, 2002; Mauzy & Erdman,

1997; Trepal, Bailie, & Leeth, 2010; Wong & Res, 1997; Worthen & McNeill, 1996).

Supervision is described as a formal relationship between a senior counselor who

mentors, monitors, and evaluates the work of a novice [e.g., student] counselor (Bernard

& Goodyear, 2014). In general, the results of these studies indicate poor supervision leads

to the perception of higher stress and conversely competent supervision leads to the

perception of lower amounts of stress. Counseling students indicated that poor

supervision involved unspecific and vague feedback, not feeling heard by the supervisor,

and a lack of emotional support from the supervisor (Daniels & Larson, 2001; Trepal et

al., 2010; Worthen & McNeill, 1996). Competent supervision behaviors, as perceived by

counseling students, involved clear and specific feedback, constant emotional support,

and feedback that is appropriate for the counseling student’s developmental level

(Daniels & Larson, 2001; Trepal et al., 2010; Worthen & McNeill, 1996).

Other researchers have explored counseling students’ perceptions of practicum

including the phenomenon of anxiety, stress, and fear in practicum (Barbee, Scherer, &

Combs, 2003; Edwards & Patterson, 2012; Hill, Sullivan, Knox, & Schlosser, 2007;

Woodside, Oberman, Cole, & Carruth, 2007). These perceptions included the hopes and

fears experienced by students. The chief fear perceived by the student was the

anticipated/expected failure of practicum, followed by potentially harming their clients,

and or an inability to handle the feedback given to them regarding their performance

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(Trepal et al., 2010). Much of the literature related to counselor training, development

and supervision is from the point of view of the supervisor, is likely reductionistic in

nature and limited in scope because it examines few psychosocial variables (e.g.,

typically stressors rather than coping), does not relate the experience from the student’s

perspective and often is not longitudinal in scope. Almost none of these studies

mentioned above focus on the coping experiences of students in practicum. Of these

studies, none utilized a grounded theory methodology to explore counseling students’

appraisal and coping in a live supervised individual practicum.

Coping

In the vignette that opened this chapter Mary was not coping as effectively as she

could given the anxiety she experienced in her live supervised individual counseling

practicum. It is likely Mary’s experienced anxiety from many sources, e.g., her personal

process of continued, constant, critical evaluation and her perception of harsh feedback

from her peers and supervisor, her dependency on her supervisor and her perceived lack

of support from her practicum peers. If Mary is unable to adequately cope with her stress

and anxiety it will most likely continue to interfere with her ability to function, learn, and

display new skills in an appropriate and timely manner (Stoltenberg & McNeill, 2010).

Coping with stress has been the lifelong work of Richard S. Lazarus and Susan

Folkman (e.g. Lazarus, 1966; Lazarus & Folkman, 1984; Folkman & Lazarus, 1985;

Folkman & Lazarus, 1988; Lazarus, 1999; Folkman & Moskowitz, 2000; Folkman &

Moskowitz, 2004). Lazarus and Folkman’s model of stress and coping is known as the

appraisal model of coping. In their model, a person perceives some sort of stressor from

within themselves or in their environment and appraises or evaluates this stressor for the

7

proper reaction. A key factor in the appraisal theory is the individual’s perception of the

stress. In other words, the idiosyncratic nature of perception is paramount. For example,

one person may appraise an event as mildly stressful while another person may

experience the event as intensely stressful. The reaction to stress is a process referred to

as a coping scheme. These schemes are constantly updated as environmental stressors

change and are reassessed. Much like the interference reference by Stoltenberg and

McNeill (2010) in the preceding paragraph Lazarus and Folkman (1984) note that

difficulties which arise from faulty appraisals and or coping schemes are ineffective in

ameliorating the specific stress or stressors.

Types of Coping

A person's coping scheme falls within some combination of four types of coping:

problem focused, emotion focused, meaning focused and social focused (Folkman &

Moskowitz, 2004; Lazarus & Folkman, 1984). Problem focused coping is perhaps the

most active and straight forward as the person experiencing the stress and anxiety tackles

the source of the problem head on and actively seeks out ways in which to ameliorate the

stressors impact. Emotion focused coping is centered on dealing with the negative

emotions revealed by the stress and anxiety of the situation. This form of coping may

possibly lead to faulty coping schemes involving a variety of distracting activities

including but not limited to Drugs and alcohol use, denial and or blaming others.

Meaning focused coping often involves finding the meaning in adversity as a possible

function of coping. This type of coping may involve religious beliefs, humor, and or

existential thinking and is useful in situations of chronic stress and anxiety, such as a

terminal illness or involvement in a war. Social focused coping involves seeking help and

8

support from others. This coping strategy involves seeking out the individual's social

network of family and friends to supply comfort, support, and possibly guidance during a

stressful and anxiety producing times.

Recall the vignette of Mary, her perception of events in practicum involved

appraising other people’s behaviors as insincere or sympathetic. In effect, she perceived

her peers and supervisor’s positive feedback and attempts at support as false,

disingenuous and coming from a place of pity. Mary’s appraisals of the stressors in

practicum may also be influenced by internal beliefs of incompetence and a lack of self-

efficacy in acquiring counseling skills. Her ultimate appraisal of practicum is that she will

fail, likely resulting in an ineffective coping scheme which may lead to cognitive

restriction, becoming emotionally numb, and isolating her further from the very peers and

supervisors who want to help her. The unfortunate effect of Mary’s less than productive

coping scheme is that it will inexorably lead to her failing practicum without some means

of intervention.

Statement of the Problem

The setting of a live supervised individual practicum is by its nature a high risk

and high reward environment. Students practice skills and processes which are still in

development in real time with a real client while their peers and supervisor watch from

behind a one-way mirror. Students’ counseling skills are witnessed live, evaluated, and

discussed by the supervisor and often the students’ peers. Often, feedback is given in

front of other students and supervisors; students are expected to hear, understand and

integrate post-session feedback between sessions so that they can perform new skills and

demonstrate increased understanding over time. Understandably, this process is likely to

9

lead to increased levels of stress and anxiety. For some students, increased scrutiny may

bring a positive response (e.g., increased focus and motivation, rising to the challenge)

yet for other students various levels of stress and anxiety can lead to negative or non-

productive response (e.g., dismissing peer support and or supervisor feedback, not

engaging in reflective practice) in the form of faulty coping schemes which create

interference with their learning. Because no empirically supported training/supervision

model exists for faculty, students (and by extension the field of counselor education) face

a problem in that there is no credible reference which describes and aids students’ coping

response(s) to anxiety and stress during a live practicum. The lack of an empirical

derived model prevents students and faculty from utilizing a framework or process to

address students’ anxiety and coping in practicum. Students’ personal, academic, and

professional lives may be adversely impacted, as well as the welfare of their clients.

From my perspective much has been assumed about the process of student’s

anxiety and coping in a live practicum. Little empirical research exists that focuses on the

dynamic interrelated nature of these two experiences. The professional literature contains

numerous anecdotal works that exist which describe students’ anxiety or coping from the

perspective of the individual supervisors (Costa, 1994; Dodge, 1982; Fitch & Marshall,

2002; Heckman-Stone, 2004; Liddle, 1986; Yager & Beck, 1985) or is focused primarily

on the supervisory relationship rather than the students’ individual experiences of

practicum as a whole (Daniels & Larson, 2001; Gnika et al.., 2012; Hendrickson et al..,

2002; Mauzy & Erdman, 1997; Trepal et al., 2010; Wong & Res, 1997; Worthen &

McNeill, 1996). Fewer studies were found that focused on the student's point of view;

most of these examined counseling students’ stress and anxiety outside of the practicum

10

setting (Abel, Abel, & Smith, 2012; Smith, Robinson, & Young, 2007; Williams, Polster,

Grizzard, Rockenbaugh, & Judge, 2003; Bowman, Roberts, & Giesen, 1978) or with

post-degree professionals (Bandura, 1956) and even fewer studies located that dealt with

anxiety during practicum from a student's perspective (Barbee et al.., 2003; Edwards &

Patterson, 2012; Hill et al.., 2007; Woodside et al.., 2007).

Current theories pertaining to counselor training are neither complete or

systematic nor do they integrate the voices of the counseling students. Numerous authors

seem to focus more on techniques and pedagogical styles than on the student experiences

(e.g. Neufeldt, 2010; Truax & Carkhuff, 2000; Kagan & Kagan, 1990; Ivey, Ivey, &

Zalaquett, 2014). The goal of my study is to examine students’ live experiences in a live

practicum over time (one 15-17 week semester) so that an emergent model may be

developed.

Rationale for the Study

As a doctoral student I have repeatedly engaged in the training of counselors via a

live supervised practicum. Through this process I have witnessed students’ anxiety,

stress and their struggles to cope. The professional literature provides little guidance or

explanation from the students’ perspective regarding these experiences or direction

regarding how I could assist students’ learning as the supervisor. The rationale for this

study is to intentionally and meaningfully examine students’ experiences of stress and

coping during a semester-long live supervised individual practicum in hope of identifying

an emergent theory that describes this process. By having a clearer understanding of

stress and coping in practicum, students and supervisors may have better guidance to

recognize normative responses and when responses are non-normative, know when and

11

how to intervene and support students. Supervisory intervention and support are believed

to be critical during practicum; a process fraught with non-productive anxiety and the

struggle to cope.

An emergent theory could empower and assist students to engage in their own

learning. It has been my experience that the better a student copes with anxiety, the better

that student will perform in a live practicum. Hopefully, the results of this study will

inspire and foster future research as well as add to the empirical basis for counselor

training in general.

Significance of the Study

The reader may be asking themselves at this point why this study is needed when

so many students do in fact pass practicum. One answer is that although many students

do pass, this passing does not necessarily equate to an optimum training experience,

feelings or readiness, or solid foundation of professional self-management. The results of

this study could aid students in having: (a) a deeper understanding of their role and

contribution to their training and the counseling dynamic, (b) an experience of greater

mastery over their learning environment, and (c) the potential to increase their self-

directed learning. Additionally, I hypothesize a disconnect between what faculty believe

they are modeling and teaching and what students’ experience in practicum. It can be

safely assumed that almost all faculty strive towards helping their student's succeed.

However, what if faculty are using strategies and techniques in such a way that increases

stress and anxiety and or decreases student's abilities to cope? Discovery of an emergent

theory may be able to illuminate whether the hypothesized disconnect exists and more

importantly what faculty and students may do to bridge that gap. The results of this study

12

could also provide a preliminary empirically supported framework to address students’

needs or to inform students of the expected developmental crises they may encounter

during their training. Finally, this study will empower students through the inclusion of

their voices and inform the counseling literature as to the students’ experience during the

developmental process. Students’ voices enrich our understanding of counselor training

and inform our pedagogy.

Guiding Objectives and Questions

Adult learning and counselor development theories as well as the appraisal model

of stress and coping (Lazarus & Folkman, 1984) form the conceptual foundation for this

study and guide my inquiry. The guiding questions below provide conceptual boundaries

to the study:

Q1 What are the perceptions, experiences, and narratives of students

regarding their stress and coping during a live supervised individual

practicum?

Q2 How do the perceptions, experiences, and narratives of students regarding

their stress and coping in a live supervised individual practicum relate to

models of adult learning, counselor development, and appraisal theory?

Q3 What, if any, relationships exist among and between students’ perceptions,

experiences, and narratives of stress and coping during a live practicum?

Delimitations

This study is limited to the unique experiences of masters students from a Council

for Accreditation of Counseling and Related Programs (CACREP) accredited counseling

program. It is more specifically limited to those experiences of anxiety and coping in a

live supervised individual practicum. Although every effort was used to protect the

anonymity of the nine student participants, many students expressed concern over

professors or doctoral students learning about what was disclosed by them during the

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study. It remains a possibility that for this reason, as well as limitations surrounding

difficulties with self-reporting (e.g. social desirability) the results of the present study

should be viewed with caution.

Definition of Terms

Adult Learners. The adult learner as someone who (1) has an independent self-concept

and who can direct his or her own learning, (2) has accumulated a reservoir of life

experiences that is a rich resource for learning, (3) has learning needs closely

related to changing social roles, (4) is problem-centered and interested in

immediate application of knowledge, and (5) is motivated to learn by internal

rather than external factors (Merriam, 2001).

Anxiety. an unpleasant emotion triggered by anticipation of future events, memories of

past events, or ruminations about the self. (Harris & Thakerey, 2003).

Appraisal. A Process involving the assessment of incoming stress by answering two key

questions. "Is this stressful event a problem or an advantage, now or in the future,

and which ways?" and, "What if anything can be done about it?" (Lazarus &

Folkman, 1984, p. 16).

Council for Accreditation of Counseling & Related Educational Programs

(CACREP). The vision of CACREP is to provide leadership and to promote

excellence in professional preparation through the accreditation of counseling and

related educational programs. As an accrediting body, CACREP is committed to

the development of standards and procedures that reflect the needs of a dynamic,

diverse, and complex society (CACREP, 2011a).

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Coping. Thoughts and behaviors that people use to manage the internal and external

demands of situations that are appraised as stressful. (Folkman & Moskowitz,

2004, p.745).

Coping Scheme. The total set of strategies devised and employed by a person to

effective or ineffectively respond to the perceived stress in their environment

(Lazarus & Folkman, 1984).

Counseling. Counseling is a professional relationship that empowers diverse individuals,

families, and groups to accomplish mental health, wellness, education, and career

goals. (Linde, 2010, p.5).

Counseling Laboratory. A counseling clinic that is internal to the department with the

ability for close or live supervision, taping of sessions, and other learning

experiences. (Wester, 2010, p.2).

Live supervision. Live supervision combines direct observation of the therapy session

with some method that enables the supervisor to communicate with the supervisee

(Bernard & Goodyear, 2014, p. 264).

Practicum. A distinctly defined, supervised clinical experience in which the student

develops basic counseling skills and integrates professional knowledge. The

practicum is completed prior to internship. (CACREP, 2009).

Stress. Psychological stress is a particular relationship between the person and the

environment that is appraised by the person as taxing or exceeding his or her

resources and endangering his or her well-being (Lazarus & Folkman, 1984, p.

19).

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Supervision. A tutorial and mentoring form of instruction in which a supervisor monitors

the student’s activities in practicum and internship and facilitates the learning and

skill development experiences associated with practicum and internship. The

supervisor monitors and evaluates the clinical work of the student while

monitoring the quality of services offered to clients. (CACREP. 2009).

16

CHAPTER II

LITERATURE REVIEW

There is nothing either good or bad, but thinking makes it so.

-- William Shakespeare

The Shakespeare quotation sets the tone for Chapter II in which the literature

related to the processes and experiences of counselors in training (CIT) in live supervised

practica is explored. Students are believed to engage in appraisal processes, assumption

formation and foreclosure that results in dichotomous thinking and in the early stages of

their training, increasing anxiety or perceived stress (Loganbill et al.., 1982; Stoltenberg

& Dellworth, 1988). Specifically, the relevant research literature in adult learning,

counselor development, counselor training, experiences of CITs, models of supervision,

and the appraisal model of coping and stress provide the theoretical basis for this study. A

comprehensive search of Academic Search Premiere, ERIC, PsychArticles, and

PsychINFO databases was conducted and focused on the flagship journals in counseling,

counselor education, psychology, education, nursing and social work. The scope of this

search was deemed broad enough to capture literature related to the training of novice

helping professionals and restricted enough to amplify counseling in particular. A 20 year

time-span (1992 to 2012) was used to examine the most current literature in the area of

counselor training clinical supervision.

Counselor Training Context

It is generally accepted that the process, environment, and standards by which

counseling students are trained in a live practicum are central to their experiences,

17

perceptions, and ultimately their success (Mobley & Myers, 2010). Most CITs

enter graduate school as adult learners who have typically been successful in other

endeavors yet enter graduate studies with some trepidation (Fairchild, 2003). Therefore, it

is important to understand the characteristics of adult learners because adult learners are

impacted by stress and anxiety differently. The history of current practices and standards

that guide the training of counselors at the graduate level based in adult learning is also

examined.

Characteristics of Adults Learners

Malcolm Knowles is frequently cited as a leader of adult learning theory or

andragogy; the bulk of his work emerged in the late 1960s and continued through the

mid-1980s. Knowles’ provided the underpinnings of educational theory and practice

(Davenport & Davenport, 1985; Pratt, 1993) that are utilized today in institutions of

higher education and across numerous disciplines. Over the course of his professional life

Knowles’ (1980) identified six characteristics of adult learners and the elements of adult

education that emanate from these characteristics. His foundational assumptions rest on

the belief that adult learners have matured beyond the stage of early adulthood and that

not all adults will progress the same. The six characteristics include: (a) advancing self-

concept reflects the transition from a dependent learner to one who is more self-directed,

(b) utilization of one’s experience as a rich resource for learning, (c) readiness to learn is

a relationship between the immediate relevance of the subject matter and adults increased

interest, (d) an orientation to learning in which the learner is more problem centered than

subjected centered, (e) a greater sense of internal motivation, curiosity, and the desire to

18

achieve and in 1984 Knowles identified the six characteristic of adult learners (f)

relevance or the need to know ‘why’ something needs to be learned.

Knowles’ description of adult learners was selected as the basis of this study

because most applicants to counseling programs reflect the characteristics described by

Knowles (Woodward & Lin, 1999). Consistent with Merriam’s (2001) thoughts on adult

learners, counselor educators’ could anticipate that the students are self-directed, use their

life experiences to enhance their learning, have learning needs related to their changing

roles, and are more internally as opposed to externally motivated. Additionally, in their

description of adult learners Cafferella and Barnett (1994) emphasized that adult learners

have multiple ways in which they learn and have an expectation to be active participants

in their learning

More than any other single factor, use of a rich storehouse of experiences

differentiates adult learning from the learning process of children (Cafferella & Barnett,

1994). Adults organize and make meaning of their learning through the integration of

new information with their experiences and prior knowledge. Instructors of adult learners

who are mindful of students’ prior experiences can construct comprehensive, integrated

and relevant experiences for their students. For example, in counseling role plays,

reflection journals, and portfolios, a live practicum allow adult learners the opportunity to

use relevant and rich experiences as a resource to enhance their own and other student’s

learning. In particular, peer feedback may be more meaningful when it comes from a

place of personal experience.

For counseling students the motivation to learn can carry both internal and

external components, typically with the internal being more powerful (e.g., a counseling

19

student may be externally motivated to pass live practicum so that they can continue on

with their program and not risk embarrassment, failure or shame). However, hopefully a

stronger internal motivator may be to learn the skills necessary to help clients better cope

with their lives.

Adult Learning

Five schools have emerged over the past 50 years, sometimes parallel to or in

contrast of Knowles’ work (Marquardt & Wardill, 2010). The schools, described by

Marquardt and Wardill (2010), are: behavioral, cognitive, humanist, social, and

constructivist. The behavioral school, based on traditional behaviorism focuses upon

control of the antecedents to learning. This school has three basic components: (a) when

behavior changes, learning has occurred; (b) learning is determined by environmental

factors; (c) and learning is solidified by reinforcement and repeated exposure to material

as documented in some form of assessment or measurement. The cognitive school

focuses on the individual’s ability to comprehend knowledge and associate it into their

past experiences. In the cognitive school, individuals reorganize information to make it as

useful to the individual as possible. Efficient use of knowledge is the key. The third

school, humanism, focuses on the emotional components of learning, coupled with the

individual’s Drive towards self-directed learning. Social learning focuses on learning

through observing and imitating others in action; much like what Bandura described

(1977). Finally, constructivist learning focuses on the context dependent nature of

knowledge construction and the individual meaning the person makes from her or his

learning (Marquardt & Wardill, 2010).

20

All the five schools presented above may be experienced by students through the

role play method of instruction. Role plays, a common learning activity in counselor

training, are used to introduce and refine specific counseling skills. For example,

practicum students typically engage in or observe their peers in mock counseling

sessions. From a behaviorist’s perspective, the role play allows for the demonstration of

newly acquired skills. This demonstration indicates that learning has occurred through

some form of assessment and reward. The cognitive school would highlight how

efficiently CITs were able to integrate improved skills through associations made with

previously learned information. In this school of thought the students would

incrementally improve the skills demonstrated. Humanist elements are exemplified

through emotional experiences and support present in the debriefing that occurs at the

conclusion of the role play as often group members discuss emotions such as fear, anger,

or joy evoked by the role play experience. The social learning school emphasizes the

observational and group meaning making components of this exercise; students learn new

skills by watching each other demonstrating them in real time. Finally, from the

constructivist perspective, the role play allows the CITs involved to actively co-creating

an experience together from which the learning and meaning made would be individual

to each student.

From my perspective, the constructivist school most closely aligns with the

process of training counselors. The constructivist school has at its heart, respect for the

subjective processes of the learner. Knowledge does not sit somewhere waiting to be

discovered, it is constructed by an active, engaged, self-directed learner who then makes

meaning of it (Baumgartner, 2001). The same can be said of the counseling process.

21

From a constructivist frame of reference, there is no objective truth or external meaning

to the life struggles of the client's; the meaning the client makes of their world is the

focus of psychotherapeutic intervention (Young, 2009). Therefore, the constructivist

school of thought provides a foundation for this study, and can be well-integrated with

elements of transformational learning (Mezirow, 1996) and counselor development.

Transformational Learning

The transformational learning model is presented here as a way to synthesize the

assumptions of adult theory, counselor development, and clinical supervision into one

theoretical foundation for the study. Transformational learning has four basic

philosophical underpinnings: (a) empowerment of the learner and society; (b) a

constructivist approach to knowledge; (c) belief in a developmental structure to learning;

and (d) an understanding of the link between spirituality and learning (Baumgartner,

2001). The transformational learning model focuses upon the meaning an individual

makes of their learning process (Marquardt & Wardill, 2010; Clark, 1993; Baumgartner,

2001) and is believed to create changes within the learner who is then shaped by and in

turn shapes her or his future learning (Clark, 1993). For example, a practicum student

may experience the feedback from a counseling session as negative and critical despite

the intent or desire of the supervisor. The student could in turn become increasingly

anxious and foreclose on future learning. The student’s perspective will likely impact the

student’s ability to receive and integrate additional or alternative feedback, particularly

positive feedback (Loganbill et al.., 1982).

The transformational approach to learning and a belief in adult development has

been the major focus of Jack Mezirow work (Clark, 1993; Baumgartner, 2001) and most

22

salient in the adult education literature (Clark, 1993; Baumgartner, 2001). Mezirow

(1998) identified critical reflection as one of the key components for the adult learner.

Critical reflection allows the adult learner to solidify her or his performance and to

identify areas of growth for future exploration. It is this component of transformational

learning that fits best with the live practicum model of instructing counseling student's.

All learning activities in a live practicum are, in part, created with the goal of having the

student critically reflect upon their own newly emerging skills and competencies. Ideally

the practicum student should be aware of their strengths and weaknesses, relative to their

professional development and be able to accept these critical reflections as factors to

improve upon in their future practice (Stoltenberg & McNeill, 2010).

Counselor Development

Development, in general, refers to the dynamic process in which a person grows

and develops over time as part of an expected process supported by the environment or

context. This development sometimes takes the form of stages in a progression from a

less advanced to a more advanced state (Loganbill et al.., 1982). Each stage of

development presents its own challenges, behaviors, attitudes, expectations, and required

abilities to be accomplished before the person successfully enters the next stage. It is

important to note, that elements of each stage are not discrete, do not need to be fully

mastered for a developmental progress to occur, and specifically related to counselor

development, the process is recursive in nature (Loganbill et al.., 1982). However, unlike

the acquisition of skills, counselor development involves technical, personal, and

interpersonal development far beyond that of other learning and developmental processes

(Loganbill et al.., 1982; Stoltenberg, 1981). It can be argued that students learning to play

23

the piano will not likely have their worldviews and personal interactions challenge as

they develop as a pianist; the same cannot be said for a developing counselor.

The counselor developmental process provides a lens through which many

counselor educators view their students over time. Practicum instructors, in particular,

who subscribed to a developmental point of view, evaluate their students’ challenges,

behaviors, attitudes, expectations, and required abilities along a developmental trajectory.

Anxiety has been documented as a central element in counselor development, and is

hypothesized to intensify during the early stages of development (Loganbill et al.., 1982;

Williams, et al.., 2003; Mauzy, Harris, & Trusty, 2001; Trepal et al., 2010; Neufledt,

2010) and influences learning in practicum (Borders, Fong-Beyette, & Cron, 1988) yet

scant commentary exists related to CITs experience of this expected anxiety and even

less on the how supervisors may best address it.

Models of counselor development. There are numerous models, theories and

structures that describe the training of counselors (Bernard & Goodyear, 2014) dating

back to the 1960s (Holloway, 1995). In the 1980s counselor educators and psychologists

sought to organize and systematize the current knowledge base (Bernard, 1979; Loganbill

et al.., 1982; Stoltenberg, 1981) to improve training and research. Developmentalist like

Loganbill, Hardy and Delworth and Stoltenberg, identified the specific stages and

associated tasks for counselors in training, many of who were in live counseling

laboratories. For the purpose of this study, the work of Loganbill, Hardy and Delworth

and Stoltenberg provide the context and rationale that guide that inquiry.

Loganbill, Hardy, and Delworth (1982) derived a complex model of counselor

development from existing literature, their anecdotal experiences and observations of

24

counseling students. Loganbill, Hardy and Delworth's model consists of three stages. The

first stage, stagnation, describes a counselor who has a naive unawareness about the

difficulty of the tasks set before him or her displays a rigid or inflexible world view and

struggles to accommodate ambiguity. The term stagnation was selected to summarize the

notion that the trainee is metaphorically stuck in previous ways of knowing and

functioning, much like Knowles’ (2011) notion of the adult learner’s reliance on personal

experience. Confusion, the second stage, describes an increase in the understanding and

awareness of how challenging the journey is. This awareness and understanding were

believed to perpetuate feelings of self-doubt, anxiety, disorientation, lack of tangible

answers, and increasing ambiguity and discomfort. Specifically, Loganbill, Hardy and

Delworth described this stage as a time of great upheaval, in which student experience

random, compensatory and or counterproductive behaviors, and a flurry of panic as they

desperately attempt to reach some form of equilibrium relate to their self-efficacy and

anxiety management. This distress is most keenly felt during the confusion stage as

Loganbill, Hardy, and Delworth described, "Old ways of behaving and thinking have

been shaken and shattered leaving open the opportunity to be replaced by a new and fresh

perspective" (1982, p. 19). This aptly named stage describes both the content and process

of the student’s experiences. The final stage, Integration, describes the process in which

the student experiences reduced anxiety, increased self-efficacy and intentionality, and

greater acceptance of the inherent ambiguity of counseling. Students literally and

metaphorically are believed to leave fragmented understanding, counterproductive

anxiety and fear behind and emerge into more self-directed fully engaged learners who

possess an integrated understanding of the counseling process.

25

Cal Stoltenberg, who studied under Delworth at the University of Iowa in the

1980s, went on to develop the Integrated Developmental Model (IDM) of counselor

training. IDM is, in part, may be viewed by some as an extension of Loganbill, Hardy and

Delworth’s ideas. However, Stoltenberg and McNeill (2010) has added a fourth Level to

his model (3i) in order to demonstrate continued development beyond graduate training.

Stoltenberg's four Levels parallel and extend Loganbill, Hardy, and Delworth’s (1982)

original work. Level one of IDM is described an entry-level counselor trainee who

experiences high motivation and anxiety. At Level two, counselor trainees often

experience wild fluctuations in motivation, nature and type of anxiety, and confidence.

Level three is characterized as an essentially stable period, wherein the counselor trainee

experiences balanced self-efficacy, manageable anxiety and confidence appropriate to his

or her level of skill. Finally, level 3i (integrated) is characterized as a supervisor who is

integrated and advanced upon multiple domains of practice, understands her or his

strengths and weaknesses, and can effectively deal with stress and anxiety.

Loganbill, Hardy and Delworth and IDM are necessary but not sufficient models

of counselor development. Both have been criticized for being incomplete, seem to focus

on counselor development only during the training/educational phase of counselor

development and seem to provide little to no guidance for the lifelong development of

counselors (e.g., Holloway, 1987). Ronnestad and Skovholt (2003; 2013) derived an

emergent model of counselor development encompassing the dynamic phenomenon

inherent in the professional lifespan of development for counselors. Ronnestad and

Skovholt interviewed over 100 counselors across the professional lifespan. The results of

their research formed the basis of an emergent model comprised of six phases. These

26

phases include: the lay helper, the beginning student, the advanced student, the novice

professional, the experienced professional, and the senior professional. For information

on the lay helper phase, the reader is directed to Ronnestad and Skovholt’s 2003 text. The

second phase, which is consistent with the focus of the present study, describes a

beginning student with little or no education or training in counseling, this student often

gives advice, may demonstrate boundary issues, and often expresses sympathy instead of

empathy. Consistent with other models of counselor development, an individual in the

beginning phase is a student in formal training who experiences anxiety dependence, and

vulnerability whereas the advanced student experiences confidence in their abilities and

acceptance their strengths and weaknesses. This phase of development is synthesized

along with the information from Loganbill, Hardy and Delworth and the IDM model to

provide a theoretical foundation and understanding to the present study. The professional

phases (e.g., post formal training) are characterized by the counselor experiencing relief

of being in formal training to awareness that there are few certain answers to counseling.

Psychotherapy for this counselor becomes more and more personalized and flexible, is

based upon the client's needs and in the experience professional, a sense that professional

knowledge comes from “within” her or himself. Finally, the senior professional has

developed a very personalized and authentic ways of working with clients and an

acceptance of his or her professional way of being. The post-student phases are

interesting as they demonstrate continued learning and growth, yet the experience of

stress and coping appear to be greatly reduced.

Criticisms of developmental models. Although developmental models of

counselor training appeared to be the standard of counselor education, in 1987 Holloway

27

questioned their accuracy and utility. She noted developmental models were loquacious,

needlessly complicated, likely no different than the process of skill acquisition in other

professions, and did not adequately describe the progression between and among

developmental stages. Holloway especially cited the work of Loganbill, Hardy, and

Delworth (1982) as an example of a needlessly cumbersome theoretical presentation.

Stoltenberg and Delworth responded to this specific criticism by noting that the process

of becoming a counselor was a dynamic and long term one and the theory created to

explain this phenomenon must be “sufficiently robust to explain and accurately predict

behavior while stimulating and guiding research and practice” (Stoltenberg & Delworth,

1988, p. 135).

Holloway also questioned whether or not the acquisition of skills and the process

of professional development for counselors were distinct or different from the skill

development in any other profession. Undoubtedly, many parallels exist, yet from my

perspective, counselor development is distinct because of the centrality of the counselor’s

personhood, the process of personal reflection, and preeminence of client welfare. There

exists an entire body of literature in counseling devoted to the importance of the

personhood of the counselor. Numerous authors describe the unique personal

characteristics necessary for effective psychotherapy (Kottler, 2010; Wiggins &

Westlander, 1979; Young, 2009). For example, when a new counseling student enters

practicum he or she may regress to an earlier stage of development to in order to cope

(Stoltenberg & Delworth, 1988). Counselors-in-training may be less able to cope with

daily stressors, engage in rationalizing or displacement, or experience a decline in

previous levels of self-efficacy. This regression is evidenced in other professions, like

28

nursing (Kim, 2003) where students are expected to practice on patients for whom the

consequence of failure could be profound. According to Kim, this regression exists in

part in response to the anxiety generated by the looming threat of harm to the patient,

which was ever present in nursing practicum. This parallels the anxiety generated for

CITs by the looming threat of harming a client in practicum.

Holloway’s final criticism revolved around the lack of specific understanding of

how counselors transition from one stage to another. I would argue that, now, we do

understand better how CITs’ progress from stage to stage based upon the research

support for the counselor development model. There have been studies into the

qualitative changes students experience through their development (Hill et al.., 2007;

Ronnestad & Skovholt, 2003), using increases in counseling student cognitions

(Granello, 2004), and changing behaviors of counseling students within and between

phases (Heppner & Roehlke, 1984; Worthington, 1984; Rabinowitz, Heppner, &

Roehlke, 1986). Although counselor development models are rightly criticized for the

incompleteness (Borders, 1989) it is important to note, despite these criticisms that no

substantive model of counselor training has, to date, supplanted it.

Clinical Supervision

Clinical supervision has been broadly defined by Bernard and Goodyear (2014) as

an intervention provided by a more senior member of a profession to a more junior

member of the same profession. Further they defined clinical supervision as a

relationship that extends over time, is hierarchical and evaluative in nature. This

definition of supervision has become widely accepted by most scholars and researchers

working in the field today (Falender, Cornish, Goodyear, Hatcher, Kaslow, & Leventhal,

29

2004). Supervision can further be broken down into three separate categories or models

that guide supervision practice: the psychological, the social role, and the developmental

models of supervision. Psychological models provide for the direct application of the

psychological theories and ideas that govern clinical counseling practice with clients

(e.g., psychodynamic, systemic). Social role model supervision focuses the relationship

between the supervisor and the supervisee; more specifically the way in which the

supervisor adapts her or his roles to better facilitate the supervisees learning.

Developmental supervision (Bernard & Goodyear, 2014) is a stage-based model that

describes the process of learning and growth, anticipated crises, and expected behaviors a

counselor is likely to exhibit throughout her or his training (Loganbill et al.., 1982;

Stoltenberg & McNeill, 2010) and professional lives (Ronnestad & Skovholt, 2003). This

study is rooted in the counselor development model consistent with developmental

supervision.

According to the developmental model of supervision, the supervisor has multiple

goals which include insuring client welfare, enhancing student growth within each phase

of development, aiding in the transition from one stage to the next, and evaluating

supervisee skills (Loganbill et al.., 1982). In order to accomplish these goals, the

developmental supervisor calls upon multiple techniques: facilitative, prescriptive,

conceptual, and catalytic (Stoltenberg & McNeill, 2010). Facilitative interventions

involve supporting the student emotionally regarding their burgeoning abilities and even

placing their setbacks into a larger developmental scheme. Facilitative interventions are

considered to be the most direct mechanism supervisors utilize to support their students

experience of stress and anxiety in practicum. Prescriptive interventions or direct

30

instruction are systematically employed in the early developmental stages as they provide

structure, security and predictability to the learning process. Caution should be used

around prescriptive interventions as they may cause increased dependence on the

supervisor. From my experience with CITs, prescriptive interventions may be the least

anxiety provoking for the student. This may be due to the student’s perspective that the

responsibility for therapeutic interventions shifts from the student to the supervisor.

Stoltenberg and McNeil (2010) suggest use of conceptual techniques to foster a greater

sense of autonomy for the student. These experiences link the real world practice of

providing counseling within the structure of theory, diagnosis, and ultimately treatment

planning. Conceptual interventions may also provide a source of stability for the anxious

practicum student because they provide the student a hypothesized structure from which

to work. Finally, catalytic interventions are used to help the student transition from one

developmental stage to another. Catalytic interventions are designed to challenge the

student’s comfort zone and hopefully refocus the student’s energy away from themselves

and their anxiety towards the therapeutic process of the client.

Anxiety in Practicum

A plethora of research focused on students’ anxiety during practicum exists, yet

much of what exists is greater than 10 years old. The literature reviewed here reflects

only the most relevant and representative works and is organized into three categories: (

(a) the supervisory relationship (Daniels & Larson, 2001; Gnika et al.., 2012; Trepal et

al., 2010; Worthen & McNeill, 1996), (b) the student's point of view of stress and coping

in their general training (Abel, et al.., 2012; Smith et al.., 2007; Bowman & Roberts,

1979; Bowman et al.., 1978; Bandura, 1956), and finally, (c) anxiety during practicum

31

from a student's perspective (Barbee et al.., 2003; Edwards & Patterson, 2012; Hill et al..,

2007; Woodside et al.., 2007; Mauzy & Erdman, 1997; Mauzy et al.., 2001; Schauer,

Seymour, and Geen, 1985; Wong & Res, 1997). Due to the nature of the proposed

research design, grounded theory, the only the most salient literature in each section is

reviewed and critiqued. This more selective focus is believed to provide the reader a

broader context for the potential experiences and resulting emergent theory rather than a

linear argument for the proposed study.

Anxiety and the Supervisory Relationship

The research regarding anxiety and coping within the supervisory relationship

itself is vast. The research discussed here are the studies that have the closest alignment

to the current study. In general, these research studies reflect good supervision techniques

and a supportive supervisory relationship lead to lower reported levels of stress and

anxiety on the part of the supervisee, and that lower levels of stress experienced by

supervisees in their lives lead to stronger supervisee relationships.

For example, Gnika, et al.. (2012) compared the relative strengths of the

supervisory working relationship with the stress and anxiety experienced by supervisees.

This study also used Lazarus and Folkman's appraisal model of stress to help

conceptualize the experience of stress and anxiety on the part of the supervisee. However,

this study was unconcerned with coping strategies used by the supervisee, except to state

that positive coping was important for positive functioning in general. Two hundred

thirty-two (N=232) master's level students enrolled in practicum and internship at a

variety of locations were surveyed online using multiple measures for stress and the

supervisory working relationship. These students reported with regard to the supervisory

32

relationship, the less stress a supervisee reported and the more they perceived they were

in control of their environment, the more positive and stronger a supervisory working

alliance they experienced. The focus and findings of this study are typical of this type of

research which explores the stress and anxiety experienced by supervisees and its impact

on the supervisory relationship. More specifically, this body of research is predominantly

quantitative in nature, defines anxiety from the perspective of what the supervisor ‘sees’

and results in findings that seem to document that anxiety does indeed exist but offer few,

if any suggestions or specifics, about how to better achieve more positive outcomes.

Additional a group closely aligned research studies include those that focused on

the impact feedback had on supervisees’ view of their skills, supervisors’ view and their

relationship (Daniels & Larson, 2001). Friedlander, Keller, Peca-Baker, & Olk (1986)

explored conflict in the supervisory relationship and found that the conflict itself did not

have a major impact on supervisees’ anxiety; performance was actually impacted much

more by the supervisee’s self-talk and negative self-perceptions. Finally, many research

studies focused on the supervisees’ perspective of the supervisory relationship,

specifically supervisees’ preferences for supervisor behaviors. Two studies exemplify this

type of research: supervisee’s preference for supportive and facilitative supervisor

behaviors (Trepal et al., 2010) and supervisee’s greater connection to supervisors who

were non-judgmental, empathic, and encouraging (Worthen & McNeill, 1996). Although

these works provide perspective on the supervisee/supervisor relationships, the

contributions to the field’s understanding students’ anxiety, stress and efforts to cope are

limited, due to the scant mention of specific applicable techniques.

33

Student Anxiety in General Training

The research studies reviewed here specifically examine the stress and or anxiety

counseling students experience during their general counselor training. These studies may

also serve as support for the wellness and self-care movement currently in counseling,

especially as it extends to counseling students. Many of these authors offered curricular

and programmatic recommendations for counselor educators, trainers, and supervisors

focused on a self-care component in counseling students’ training (Lawson, 2007;

Chandler, Bodenhamer-Davis, Holden, Evenson, & Bratton, 2001; Myers, Mobley, &

Booth, 2003; Abel, et al.., 2012; Myers & Williard, 2003; Roach & Young, 2007; &

Schure, Christopher, & Christopher, 2008).

A typical example of research focused on the general stress of graduate

counseling programs would be the work of Abel, et al.. (2012) that highlighted the

outcomes of a stress management course on student counselors. These authors noted the

multiple sources of stress experienced when they wrote, "Graduate students in counselor

preparation programs are inundated daily with an infinite number of internal and external

stressful experiences, such as grades, comprehensive exams, professor demands,

competition, intense worry, self-doubt, and even isolation" (p. 65). A pre- and post-test

design was used to investigate the experience of anxiety in 101 masters level counseling

students. The authors employed the strait-trait anxiety inventory, the perceptions of

stressful situations questionnaire, and a researcher created questionnaire that examined

the participant’s knowledge of stress and stress management techniques. Abel, et al..

(2012) found that overall the stress management course seemed to improve the reported

levels of stress and anxiety for students. However, these authors made no mention of the

34

exact mechanism through which students attending this class were better able to cope

with their stress.

Student’s Perspective of Anxiety in Practicum

This group of studies are differentiated from the previously examined literature in

that the studies that follow are focused on the students’ perspective of stress and coping

in practicum (Arthur & Gfroerer, 2002; Edwards & Patterson, 2012; Mauzy & Erdman,

1997; Barbee et al.., 2003; Hill et al.., 2007; Koltz & Feit, 2012; Trepal et al., 2010).

These studies were conducted with student participating in a variety of practica,

including: family and individual therapy, doctoral and masters level students, live and

field based experiences, and pre-practicum (i.e., confederate clients). It is important to

note that the vast number of these studies was conducted in the training of family

therapists.

Hill et al.. (2007) qualitatively examined the phenomenological experiences of 5

counseling psychology doctoral students in their first experience in practicum. Over the

course of a 15-week semester, students in the practicum were asked to journal one to two

type written pages about a variety of topics they could choose from: anxiety, clinical

skills, psychotherapy theory, multicultural issues, the therapeutic process with clients,

receiving and incorporating feedback, and reactions to supervision. Hill et al.. (2007)

wanted to follow the students over the 15-week semester because it was their belief in the

developmental model that student reactions would grow and change over the semester

long period. The researchers cited the integrated developmental model put forth by

Stoltenberg and McNeill (2010). Hill et al..'s research team coded the qualitative data into

5 themes: (a) challenges related to becoming psychotherapists; (b) gains related to

35

becoming psychotherapists; (c) supervision; (d) activities other than supervision that

fostered awareness.

Of these themes uncovered by Hill et al.. (2007) the most salient to the proposed

study was the challenges related to becoming psychotherapists as within this large theme

is the stories of students who experienced anxiety during practicum. Hill et al.. (2007)

wrote the following about anxieties experienced by students:

All trainees felt quite anxious about beginning to see clients: They worried

about knowing what to do in sessions (e.g., “My main feeling . . . was that

[the client] had so many different things going on with her ‘coming out’

that I didn’t even know where to go first.”) and felt pressured to do the

“right” thing to be a good psychotherapist (e.g., “I still find myself

worried about saying the right thing. My mind thinks very quickly and it is

sometimes hard for me to quiet my mind and articulate the thoughts into

coherent statements.”) (p. 439.)

Students also reported often feeling overwhelmed and worried that their clinical skills

were inferior, that they over identified with the client's struggles, and that they found it

difficult to integrate the feedback they received into their practice (Hill et al.., 2007).

However, as time passed, these trainees became more confident in their abilities and their

weekly journal entries began to reflect these positive gains. Hill et al.. (2007) made no

mention of any technique or mechanism by which student's gained confidence or positive

gains, citing it as a function of experience.

Hill et al..'s (2007) study was typical of this type of research (Trepal et al., 2010;

Barbee et al.., 2003; Arthur & Gfroerer, 2002; Edwards & Patterson, 2012; Koltz & Feit,

2012; & Mauzy & Erdman, 1997) in several ways; foremost, it was qualitative in nature.

Most of the research uncovered used qualitative and phenomenological research tools and

paradigms to allow students to tell their own stories of their experiences in practicum.

However, Hill et al..'s (2007) study was also typical in that it did not address the coping

36

schemes employed by students and instead focused on other constructs, in this study it

was the developmental model put forth by Stoltenberg and McNeill (2010). Finally, this

study reflected what was uncommon in many studies of this nature, a professor or

supervisor, in this case the lead author Hill, utilized a practicum in which the study

participants were also students of one of the members of the research team. To better

reduce the potential for bias, Hill et al.. analyzed the data after the semester was over.

However, obvious ethical issues emerge, most notably participants’ right to refuse to

participate which then calls into question the mostly positive, almost glowing, remarks

students made about supervision, the feedback they received, and their overall

experiences in practicum.

Appraisal Model of Stress and Coping

As demonstrated in the previous sections on counselor development and students’

experiences of anxiety in practicum anxiety and stress permeate many students’ initial

practica. Scant research exists in counselor education that specifically addresses the

nature of stress and coping of students in training. Stress and coping research has been

led over the past thirty years by the theoretical work of Richard S. Lazarus and Susan

Folkman (e.g., Folkman & Lazarus, 1985; Folkman & Lazarus, 1988; Folkman &

Moskowitz, 2000; Folkman & Moskowitz, 2004; Lazarus, 1966; Lazarus & Folkman,

1984; Lazarus, 1999;). As Tennen, Affleck, Armeli, & Carney (2000) stated, "Lazarus

and Folkman offer the most widely accepted definition of coping: changing cognitive and

behavioral efforts to manage psychological stress" (p. 626).

37

Appraisal of Stress

Lazarus and Folkman’s (1984) theoretical model of stress and coping involves the

appraisal of incoming stress in two ways. Primary appraisal, in which the person asks

themselves, "Is this stressful event a problem or an advantage, now or in the future, and

which ways?" (p. 16). Secondary appraisal, in which the person asks themselves, "What

if anything can be done about it?" (p. 16). Although Lazarus originally named these two

appraisal processes primary and secondary, he later came to regret these labels as these

processes typically occur simultaneously or in a different order depending on the

individual (Lazarus & Folkman, 1984). Figure 1 presents a synthesized construction of

the evolution of Lazarus and Folkman’s models from 1984-2004.

Primary appraisal involves three possibilities, a stressful event or process can be

considered irrelevant, benign-positive, or stressful. Lazarus and Folkman (1984) point out

that these last two appraisals, benign-positive or stressful can be experienced for the same

phenomenon. For example, a job promotion can be viewed with excitement and

anticipation while feeling stressed at the increased responsibilities and expectations

simultaneously. Primary appraisal is influenced by and influences secondary appraisal.

Secondary appraisal involves a dynamic process of understanding: What is at

stake or at risk? What are my possible coping strategies? What are my coping resources?

and What is the possible success or failure of any coping strategy or episode? The

answers to these questions may also depend upon potential time constraints associated

with the stressful event. Obviously, the less time available to the person likely results in

an increase in the intensity of the stressful situation.

38

Figure 1. The appraisal model of stress and coping. Created from the model described in

"Coping: Pitfalls and promise," by Folkman, & Moskowitz, 2004, Annual Review of

Psychology, 55, 745-755.

39

Whereas a longer time periods or no time constraint may lead to lower levels of stress

intensity as the person has more time to gather resources, practice solutions, or ignore the

situation entirely.

After the appraisal process has been completed, the person who is experiencing

the stressful event or process, categorizes the stress as harmful, threatening, or

challenging. The new categorization process is affected and influenced by the person's

answers to the primary and secondary appraisal process.

When an experience is categorized as harmful some sort of damage or loss is

likely to have already occurred or is believed to be imminent to the person's physical,

mental, or social standing status. An experience categorized as threatening involves the

anticipation of an event or process that will most likely be harmful. An experience

categorized as challenging involves the anticipation of a good or helpful outcome from

the stressful event or process that the individual is capable of generally handling well.

However, even a challenging or helpful experience can involve stress and can utilize a

student's coping resources. It should be noted that these three categories of stress are not

necessarily mutually exclusive. For example, a situation may be appraised originally as

being threatening. However, as the person reappraises the changing situation, it becomes

apparent that there are possible positive outcomes involved in the event or process, thus

becoming a challenging stressful encounter.

The assessment of stress often leads to an emotional response. The type and

intensity of the emotional response relates to the amount of control a person feels she or

he has over a stressful event. For example, consider a counseling student in practicum is

being evaluated for the demonstration of certain skills. The student may feel anxiety

40

related to their perceived inability to successfully demonstrate the required skills, or

anger towards her or his evaluators, and even jealousy of others who may appear to be

demonstrating the skills more readily. The emotional response a person experiences in

response to stress is a complicated process that also involves the personality, self-

efficacy, disposition and lifestyle of the individual.

All of these processes contribute to the greater dynamic of the individual's stress

response. Each process may be more or less influential in person's ultimate appraisal

regarding the stressful event or process. Final appraisals have a direct impact on the

coping strategies used or not used and potentially the ultimate success or failure of one’s

coping schemes. Examples of different stress appraisals are described in Table 1. The

format and content of these scenarios were influenced by Lazarus’ and Folkman’s (1984)

original works but adapted for a counseling audience.

Coping with Stress

As in Table 1 different permutations of the stress appraisal varies widely based

upon the individual influence given to each part of the appraisal process. Now that these

appraisals have been generated, the person moves onto the process of creating a coping

scheme or plan to deal with the stress appraisal. Folkman and Moskowitz (2004) defined

coping as, "Thoughts and behaviors that people use to manage the internal and external

demands of situations that are appraised as stressful." There are a variety of ways in

which these thoughts and behaviors can be used to meet the internal and external

demands of stressful situations. In Lazarus and Folkman's original theoretical work from

the 1970s and 1980s they identified two forms of coping: problem-focused and emotion-

focused. Later, in the 1990s, as researchers would conduct studies into the nature of

41

coping from this theoretical perspective, two other forms of coping emerged: meaning-

focused and social-focused. Finally, inherent concept in this model is the construct of

reappraisal. Reappraisal is the mechanism by which the person changes coping schemes

to fit their new perception of the internal or external nature of the stressful event.

Problem-focused coping involves addressing the event or process that is causing

the stressful appraisal. There are two forms of problem-focused coping, those strategies

aimed at the outer causes of stress and those aimed at inner causes of stress. Often,

problem-focused coping involves doing both of these simultaneously. The externally

oriented problem-focused coping often involves steps in the standard problem solving

model; assessing the situation, creating possible solutions, considering the possible

outcomes of these solutions, and ultimately making a plan and acting on it. Internally

oriented problem-focused coping often involves finding new ways to express a desire or

need, becoming less attached to a specific outcome, or learning new skills and gaining

new abilities. As the problem changes through reappraisal, the person's action plan or

focus must shift accordingly to successfully cope.

Emotion-focused coping involves lessening the impact of the negative emotions

stemming from the stressful event or process. Emotion-focused coping can often come in

many forms. One such form involves ignoring or avoiding the emotional impact of the

stressful event or process. These coping strategies could include; staying busy or the use

of Drugs or alcohol. Many times emotion-focused coping involves the reappraisal or

more specifically the reframing of the stressful event or process. These emotional

reappraisals work towards either lessening or removing the negative impact of emotions

upon the person.

42

Table 1

Stress Appraisals Based on Different Influences

Each of the scenarios begin with the following initial reactions based on the

individual’s primary and secondary appraisals.

"I'm not doing very well in my counseling practicum. I will probably fail if I cannot

improve my skills. This would be terrible because I need to go into internship and

graduate soon."

Scenario 1 "I am running out of financial resources. Anticipation of high

I feel helpless as I do not understand what harm and or loss with

I need to do to improve my performance. little or no control.

No one can help me. Perhaps I am not

even worth helping.”

Scenario 2 "I believe that I have the ability to improve The stressful situation

my performance in practicum. I need to is seen more as a

practice some relaxation techniques to challenge than as a

conquer my anxiety. threat.

Scenario 3 “Well, what is the worst that could happen? Stress is relatively

I would probably have to repeat practicum. low due to the

I would not prefer this, but it would not be perception of a longer

the end of the world.” time period.

Scenario 4 “My practicum instructor is biased towards Anticipation of high

me because I am a man. All of my evaluations harm or loss from an

have been unfair and I cannot get a fair shake. outside source.

The world is basically unfair.”

Note. Created from the model described in "Coping: Pitfalls and promise," by Folkman,

& Moskowitz, 2004, Annual Review of Psychology, 55, 745-755.

Examples include statements such as, "I decided there were more important things to

worry about.”; "I realized that this was not the end of the world.”; and "I really don't need

his help after all." This reframing of the emotional impact of the stressful event or

process can then influence the reappraisal process, thereby influencing the person's entire

coping scheme.

43

Meaning-focused coping involves finding a new understanding of tragic and

stressful events and being comforted by this new understanding. This form of coping was

described in multiple studies of people who were facing a terminal illness (Folkman &

Moskowitz, 2004). Often, problem-focused coping does not work in these types of

situations because so much of what is happening is beyond the person's control.

Similarly, emotion-focused coping fails because the individual's negative emotions, such

as despair and hopelessness are too great to lessen. In these studies, people found new

ways to cope through using their values, beliefs, and faith to create new meaning in their

situations (Folkman & Moskowitz, 2004). This form of coping reflects the life and work

of Viktor Frankl (1959), who was imprisoned in a Nazi concentration camp. The only

way Frankl stated he had to cope was to find meaning from such a barbaric and inhuman

environment.

Social-focused coping has become distinct due to the results of several factor

analysis studies which highlighted the differences between seeking social support and

emotion-focused coping in general (Folkman & Moskowitz, 2004). Folkman theorized

that social-focused coping was different from emotion-focused coping because of the

internal nature of emotion-focused coping, whereas social-focused coping involves

interactions with others. Also, she noted each individual may not have a support system

on which to rely, however, everyone has the possibility of emotion-focused coping

available to them. Because social-focused coping involves help from others, the person

often lacks as much control over this coping focus as others. The intensity and quality of

social support can differ widely from person to person as well. It is possible that these

fluctuations in a person's social support may generate new stress to be dealt with as well.

44

As discussed earlier in the appraisal section of this theory, an individual can call

upon strategies from multiple coping foci to form an overall coping scheme or plan.

Often times a specific coping focus may overcome or facilitate the use of another coping

focus, in essence an individual may have a primary mode of coping (e.g., cognitive,

emotional, existential, social). For example, a counselor-in-training may be so

overwhelmed with fear (emotion) that she or he is unable to devise and implement a plan

of action and appears to not integrate feedback. Alternatively, these coping focused

interactions can facilitate each other as well. For example, a student may be able to

reframe a stressful situation as being less emotionally impactful enough to allow her or

him to effectively interact socially with others (i.e., social coping aids emotional coping).

The varieties and permutations of coping responses can be endless, based on the coping

foci employed.

The literature in counseling and counselor education has described the

developmental process of counselors-in-training and the concomitant anxiety. A lack of

information from the students’ perspective is lacking and there appears to be a disconnect

between the anxiety inherent in this process and its nature, expression, maintenance, and

resolution. The proposed study to evaluate the presence of an emergent grounded theory

is a first step in examining the relationship, if any, among these elements within the

context of adult and transformational learning theories. An emergent theory could inform

counselor educator’s understanding of the nature, expression, maintenance and resolution

of anxiety or stress from the student’s perspective, offer a connection between and among

elements of the theory, stimulate further research, inform our pedagogy, and perhaps

most importantly, provide a student voice in this process.

45

CHAPTER III

METHODOLOGY

An idea that is developed and put into action is more

important than an idea that exists only as an idea.

-- Buddha

This qualitative study explores master students’ perceptions of stress and coping

during their live supervision individual counseling practicum. Qualitative research has

been defined as any type of research that does not employ statistical or quantifiable

means of data collection and analysis (Strauss & Corbin, 1998) and is interpretive by

nature, meaning that the data collected is organized into categories and meaning.

Qualitative data involves the real world lived experiences of people in specific situations,

from specific cultures, and having specific worldviews. In this way, I, the researcher, or

more specifically my personhood as researcher, is the primary research tool. Grounded

theory is the qualitative paradigm used to guide this exploration. Grounded theory has

been defined by Charmaz (2006) as:

A method of conducting qualitative research that focuses on creating

conceptual frameworks or theories through building inductive analysis

from the data. Hence, the analytic categories are directly ‘grounded’ in the

data. The method favors analysis over description, fresh categories over

preconceived ideas and extant theories, and systematically focused

sequential data collection over large initial samples. (p.187)

In this study I examined the perceptions and experience of students’ stress and

coping in a live practicum in order to describe and synthesize their collective perceptions

in the form of an emergent theory (e.g., consistent terminology, potential relationships

46

between and among themes and or processes, and degrees of predictability). The

emergent theory presented in Chapter V explains how and in what manner masters’

students in a live supervised individual counseling practicum experienced and coped (or

did not cope) with the stress involved in this training, the existing patterns, and specific

individual, group, and curricular strategies students’ engaged that supported their

development. To that end, this chapter contains sections on: epistemology, epoche,

participants, research activities, data analysis, ethical considerations, trustworthiness, and

finally authenticity.

Epistemology

My primary worldview of teaching and inquiry is constructivism. Constructivism

refers to a social science perspective that describes how individuals construct or see

reality (Charmaz, 2006). This perspective asserts that each individual, including myself

as the researcher, makes distinct meanings out of their experiences and the world they

live in. Constructivism is grounded in the phenomenological thought that counseling

work also springs from, specifically the reality the client constructs for themselves, or in

this case the participant. The phenomenological perspective in counseling involves

understanding and respecting the unique perspectives of the clients we serve (Young,

2009). Because the lead investigator is a counselor, using this constructivist epistemology

in research is a natural extension of who I am as a person.

Grounded Theory

Grounded theory involves creating a theory that explains a specific interaction

and or phenomenon (Charmaz, 2006). Grounded theory is different in that the theory is

constructed directly from the data collected, as opposed to theory creation that relies upon

47

other theories for its creation. Grounded theory is also different from other methodologies

because of its use of the constant comparative method. The constant comparative method

involves having data collection, data analysis, and sampling all occurring at the same

time (Glaser & Strauss, 1967). Following this paradigm, data in this study was analyzed

immediately after its collection. Subsequently, new incoming data were compared and

contrasted with other data previously collected and analyzed. As the data were analyzed,

the process of theory building process began via multiple versions reading, considering,

and comparing until thematic saturation was met. This recursive and iterative process

helped guide me and helped me to modify subsequent data collection and sampling of

participants. For the purposes of this document, sampling, data collection, and data

analysis are separated to promote understanding.

Participants

Sampling. The sampling method utilized in this study had two levels; initial and

theoretical. Initial sampling involved the recruitment of student participants who met a

set of criteria created to investigate and explain the phenomenon of coping with stress

during a live supervised master’s level individual counseling practicum (Corbin &

Strauss, 2008). These specific criteria are elaborated on below. Theoretical sampling is

Driven by the data analysis that occurred simultaneous to the collection of data (Corbin &

Strauss, 2008). As the data analysis described the emergent phenomenon and I was able

to begin the construction of the theory and noticed the gaps in either theory or the

richness of the descriptions. Theoretical sampling was used to address these deficits in

the theory creation and or description.

48

The criteria for participant recruitment included: master’s students from a Council

for Accreditation of Counseling and Related Educational Programs (CACREP)

accredited counseling program, which had a live supervision component, either on

campus or field based, in which students’ sessions are observed live and feedback is

immediate and video recorded. The rationale for the CACREP accreditation criteria is

based on the belief of consistency across institutional resources, preparation and

professional identity of faculty and curricular standards in training at accredited

institutions.

Recruitment Procedures. Potential participants were recruited from CACREP

institutions in the Rocky Mountain region of the Association for Counselor Education

and Supervision (ACES) using the list-serv for the Counselor Education and Supervision

Network (CESNET) and referrals from my committee members. This region was

selected due to the high concentration of CACREP master’s programs within a

reasonable physical proximity. I desired to collect all data in a face to face manner, thus

proximal access was a priority. Invitations to potential participants were sent via email to

the program coordinator. When this individual confirmed a willingness to provide access

to the institution’s students, a follow-up phone call was used to create a face to face

appointment in which the studies parameters, risks, and resources needed were explained.

In which it was required, formal application to the department or universities research

committee was completed and a copy of the studies approved Institutional Review Board

(IRB) was made available to interested practicum instructors.

After institutional approval was secured, I visited the practicum students at their

University to describe and explain the study as well as invite individual participation.

49

This face to face contact occurred during the first three weeks of the semester. As per the

approved IRB, interested participants were given a copy of the informed consent and one

signed copy was retained (Appendix B). Student participants were also given the data

collection schedule and I answered any remaining questions. It was made clear to all

possible participants that participation in the study was voluntary and that there would be

no consequences for either participation or non-participation.

Practicum student participants. A minimum of 15 master students were initially

targeted to be recruited for this study. However, numerous issues arose during the year-

long attempt to recruit participants, thus nine were secured for the study with the

approval of my research committee. Nine participants were deemed as an acceptable

threshold for the study due to the depth and extent of the data collected. Only students in

their first practicum course were considered. This decision was made due to the relative

level of anxiety and coping strategies of students who have previously failed practicum

would be considered too acute for inclusion. I attempted reflect the current ratio of male

to female students in training programs at approximately 75% female and 25% male

(Evans, 2010) and the results are presented in Chapter IV.

Sources of Data

The sources of data for this study included semi-structured interviews, student

journal entries, member checks, epoche, and research journal entries. For improved

clarity of the timeline of research activities please refer to Figure 2. The semi-structured

interviews were comprised of a series of open ended questions meant to prompt as much

as much detail as possible from participants.

50

Figure 2. Research Plan Schedule.

These questions were Drawn from the professional literature and were refined through

the constant comparative method of data analysis described in the section below. All

interviews were digitally recorded and took place in person where possible or over the

phone. Priority was given to face to face interviews and I attempted to secure this method

of interviewing participants first. Interviews took place in a secure and confidential area

on the university campus or at a semi-public, yet secure location of the participants

choosing. Finally, to protect confidentiality, each participant was asked to create a

pseudonym at the first interview to be associated with their particular data.

Epoche. I managed personal biases prior to the study’s inception through the use

of an epoche (Merriam (2009). Moustakas (1994) describe the epoche as a series of

journal entries written by the researcher (me), prior to the commencement of the study

that describe her or his (my) biases, beliefs, and experiences concerning this

phenomenon. By formally documenting and expressing these biases (e.g., bracketing)

they are known and were available as a useful tool in the audit trail process later in the

study. I began this epoche two years ago as I became interested in this topic. The epoche

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 +1 +2

Member

Check 3

Week of the Semester

Semi-Structured

Interview

ONE

Semi-Structured

Interview

TWO

Member

Check 4

Gu

ided

Jo

urn

al 1

Gu

ided

Jo

urn

al 2

Gu

ided

Jo

urn

al 3

Gu

ided

Jo

urn

al 4

Member

Check 1

Member

Check 2

51

contains entries on what I have read, my thoughts about those readings and at times

stream of consciousness thought and beliefs about master’s students and stress.

Semi-structured interviews. Student participants completed two semi-structured

interviews during their semester long practicum. These interviews took place during the

first three and last three weeks of the term. The questions utilized (Appendix E and G)

were Drawn from a synthesis of the counseling literature and revised as part of the

constant comparative process consistent with grounded theory. This design allowed for

students’ anxiety and coping strategies to emerge and change over the course of time,

reflecting the expected trajectory of counselor development described in the counselor

development and training literature (Loganbill et al.., 1982; Stoltenberg & McNeill,

2010).

Guided journal entries. All of the student participants were asked to complete

four journal entries guided by specific prompts which were sent via email (Appendix F).

The initial prompt had participants describe their expectations of entering a live

practicum. The foci of these prompts changed over time due to the constant comparative

method of data collection described below and were focused on the students’ emotional

reactions to practicum. These journal entries were spaced out evenly between the middle

weeks of both the academic terms. For specific planned weeks please refer to Figure 2.

The purpose of these journal entries was to give student participants another form in

which to express their experiences as well as to create data that demonstrates the

changing nature of their anxiety and coping strategies.

Member checks. These member checks were completed with the student

participants three times throughout the practicum schedule via email. Please see Figure 2

52

for the timing of the member checks. Each round of member checks included the most

recent interview transcript, journal entry and the resulting codes. Participants were asked

to confirm the accuracy of the data and the relevance and congruence of the assigned

codes. Participants had two weeks to respond via email. Once participants confirmed the

codes participants were asked if there is additional data they would like to add, when

there was disagreement or clarification needed, a collaborative discussion took place to

reach clarification or resolve any differences.

Data Analysis

Through the use of the constant comparative method, data analysis began

simultaneously with initial data collection (Glaser & Strauss, 1967; Corbin & Strauss,

2008) and continued to the conclusion of the study. After the first interview had been

completed, recorded, and transcribed I analyzed the data for recurrent codes, and

fragments of meanings that could comprise emerging themes. Data analysis was

supported by the use of my research memos which allowed for an auditable trail of

conclusions for others to examine later (Charmaz, 2006; Corbin & Strauss, 2008). This

process allowed for the grounded theory to be constructed from the onset of my

interaction with the data. As the grounded theory emerged, I compared all new incoming

data with the data that had already been placed within themes, and or the greater structure

of the theory. In this way many incarnations of the theory emerged before the final

product for this study was completed (Glaser & Strauss, 1967; Corbin & Strauss, 2008).

The constant comparative method of data analysis also influenced the semi-

structured interview questions. For example, when interview participants began to

spontaneously discuss conflicts with others as it relates to the appraisal of new stressors

53

in practicum, I considered if a different form of the question or different manner of

probing was more consistent with the goals of the study.

Ethical Considerations

I sought and received permission to conduct this study from the Internal Review

Board (IRB) of the University of Northern Colorado. Further, each participant was

provided a secure informed consent document (Appendix B and C) which is now retained

by my research advisor. Confidentiality was maintained throughout the study.

Participants were asked to create a pseudonym to attach to their data which will be used

throughout the coding and grounded theory creation process. Only my research chair and

I have access to the real names and contact information for study participants.

All records involved in this study are locked in a secure location within the

research advisor’s office for a period of five years after the studies completion. My

research chair and I were the only individuals with access to audio recordings and

transcripts and at conclusion of this study all audio recordings were erased.

Trustworthiness

It is important to be able to evaluate the current studies design and methodology

to ensure that this study's results have the achieved as much usefulness as possible.

Trustworthiness is the overall concept for the set of criteria used to judge and evaluate the

quality and rigor of a qualitative study (Lincoln & Guba, 1986). This set of criteria has

become the most predominant and widely accepted means by which qualitative research

is evaluated by scholars in the field (Shenton, 2004). Trustworthiness is broken down into

four key sub-concepts or criteria, which are: credibility, dependability, transferability,

and confirmability (Lincoln & Guba, 1986).

54

Credibility

Credibility deals with the criteria which judge how well the qualitative study's

results reflect the actual reality being investigated (Lincoln & Guba, 1986). There were

two ways in which credibility was assured in the current study, member checks and peer

review. According to Lincoln and Guba, member checks are considered to be the best

method of strengthening a studies credibility (1986). Member checks allow the researcher

to continually confirm her or his understanding of the data collected. Finally, a review of

the accuracy of the data collected with the emergent themes and ultimate theory building

was completed as well. The peer review allowed for not only improved accuracy, but as a

possible source of a fresh perspective (Shenton, 2004).

Dependability

The criteria of dependability in qualitative research studies involves the ability the

study has to have its results easily repeatable by another researcher (Lincoln & Guba,

1986). This can be problematic, but not impossible, in qualitative work as the subjective

qualitative paradigm involves the changing phenomenon of the human experience and

not a static object (Shenton, 2004). Dependability was achieved in this study by the

meticulous way in which the research journal was recorded, creating a history of the

exact procedures and decisions made during the study. Dependability was also ensured

through the reflexive way in which I considered the effectiveness of questions and

journal prompts employed throughout the study as well.

Transferability

Transferability involves the extent to which the results of this study could be

applied to other situations or populations (Merriam, 1998; Merriam, 2009). According to

55

Lincoln and Guba (1986), transferability is achieved mainly through the rich and thick

description of the data collected:

Thick descriptive data—narrative developed about the context so that

judgments about the degree of fit or similarity may be made by others who

may wish to apply all or part of the findings elsewhere... (p. 19).

Shenton (2004) suggested that providing exact explanations and descriptions of the

participants involved and the data collection procedures improves the transferability of

the study’s results because the reader can decide for her or himself the degree of

transferability present. In the current study a rich thick description was achieved through

prolonged engagement with the data through the processes of coding, three rounds of

member-checking, and multiple interactions (e.g., interviews, journals) with participants.

Prolonged engagement proceeded throughout a nine-month period. Additionally, I read

and reread the data to insure saturation. Thematic saturation is defined as the

continuation of data collection until the stories, narratives, and descriptions consistently

repeat and no new codes or themes emerged (Merriam, 2009).

Confirmability

The degree to which the findings of the study's results reflect the phenomenon in

question and not the researcher’s beliefs and assumptions is at the heart of confirmability

(Lincoln & Guba, 1986). In this study, confirmability was strengthened via the reflexivity

involved in the epoche, research journal, and peer review process. The peer review

process is an important facet of confirmability in that it allowed an outsider to examine

the data collected, examination of potential biases, themes created, and the emergence of

the theory in real time. By documenting my biases and assumptions regarding stress and

coping in a live practicum before the study even began and as the study progressed, my

56

peer reviewer and I were sensitized to these biases throughout the study. Because

multiple sources of data were used the possibility of my biases and assumptions entering

into the process of theme development and theory emergence was decreased.

Authenticity

Lincoln and Guba (1986) sought to assure qualitative researchers and consumers

of qualitative inquiry that this method of research contained dependable and confirmable

results that were obtained through a rigorous and systemic process. A set of assurances

included the recognition and management of researcher/personal bias through the

application of several forms of authenticity.

The most well developed process (Lincoln and Guba, 1986) to ensure authenticity

is fairness. Fairness poses the question “Were the findings of the study represented as

fairly as possible?” or in other words, are the voice of the participants revealed

consistently with and across themes and where relevant, theories. In the current study I

insured fairness through member checks, prolonged engagement with the data, and peer

reviews of codes, themes and interpretations (Manning, 1997). The overall goal of

fairness sought to represent many, if not all of the emergent voices of participants without

reducing, distorting or forcing these responses to fit within a category pre-ordained by

me.

The other processes described by Lincoln and Guba (1986) identify four

additional processes meant to ensure authenticity, they are: ontological, educative,

catalytic, and tactical. Ontological authenticity addressed the ways in which participants

experienced personal growth and change by participating in the research itself. I

addressed ontological authenticity by asking participants directly how being a part of the

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study changed the way they thought about or cope with the stress of practicum. Educative

authenticity involved the expansion of participants’ understanding of others due to their

participation in the present study. I hope future practicum students understand their own

processes of anxiety and coping in practicum, and further that they understand the varied

possible coping schemes of their peers through the results and emergent theory

discovered by this study.

The final two process of authenticity, catalytic and tactical were based on the

results of the study. Catalytic and tactical authenticity involves empowering participants

so that they are free to participate in some sort of action (Lincoln & Guba, 1986) as a

result of their experience in this study. Thus for the participants in this study, this

authenticity took the form of greater awareness of their experiences with emotional and

stressful situations in practicum. The final guided journal prompt asked the question how

had participation in the current study impact their experience in practicum. Every

participant that responded to this prompt wrote about how being aware of their own

emotional reactions in practicum helped them to gain greater insight into their

interactions with others. Three participants would state later in a member check that

participating in this study helped them to realize that they needed to apologize or revisit

certain emotionally charged interactions they had with others.

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CHAPTER IV

RESULTS

Patience is bitter, but its fruit is sweet.

-- Aristotle

In this chapter participants’ data who reported their perceptions and experiences

of stress, anxiety, and coping as master’s students in a live-supervised individual

counseling practicum is reported. The data revealed 16 themes: anticipatory anxiety and

fear, meeting obligations outside of practicum, interpersonal conflicts, the live

supervision environment, feedback, practicum social environment, need for

perfectionism, trait anxiety, previous experience(s), support, effective supervision,

attitude change, self-care, blaming, catharsis, and finally foreclosure of coping. These 16

themes were further synthesized into three major categories based on: sources of anxiety,

influencers and modifiers of anxiety experienced, and coping strategies used. These

categories emerged from the themes and codes due to high degree of overlap of related

concepts and processes. From these codes and categories an emergent grounded theory of

stress anxiety and coping in practicum was developed. The emergent theory is presented

in Chapter V.

Participants

Recruitment procedures. Five rounds of solicitation for participants were sent

via emails and phone calls to seven universities within the immediate Rocky Mountain

region who housed CACREP accredited programs with live-supervised practica. Of this

group five rounds of follow-up calls were made and one university agreed to participate.

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Due to the lack of responses, I received permission from my research committee to

recruit potential participants from the counselor education list-serv CESNET-L, which

has over 7000 individual subscribers. Two additional emails were sent over this listserv

on May 14th 2014 and August 11th 2014. Only one individual responded from a

university on the east coast to the August 11th email. The individual was a counselor

education doctoral student and contact with their professor was attempted. This professor

never responded. Based on numerous attempts at recruitment, my research committee

approved Drawing the participants from one CACREP accredited institution. This

restriction of the participant pool is noted the limitations section in Chapter V. Data from

this study was Drawn from nine participants from a single CACREP accredited program

within a university in the Rocky Mountain region. The participants were members of

three different practica. Individual requests for participation were sent directly to

practicum instructors via email, three granted permission. An overview of the study and

elements of the informed consent were delivered in person by me. The nine participants

were recruited from an overall pool of 18 students.

Of the nine participants, eight identified as female and one identified as male; four

were enrolled in the couple's and family emphasis; three in the mental health emphasis,

one in the school counseling track, and one student was a double major in school

counseling and mental health counseling. More specific demographic information was

not collected from this group of participants due to this being the early stage of theory

development and to limit the potential for identification of participants from one

institution.

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Finally, the original study's proposal contained plans to interview practicum

supervisors was well. After consultation and approval from my committee, this

participant population was Dropped from the present study after the proposal hearing.

The rationale for this modification to the original design of the study involved difficulty

with initial recruitment of practicum supervisors and an attempt to remain focused on

student experiences in practicum. Interviewing and understanding the experiences of

practicum supervisors is again mentioned in the directions for future research section in

chapter V.

Data Collection

The nine participants completed: 16 interviews, 31 journal entries, and 20

member checks over the course of two semesters (e.g., nine months). Two semi-

structured interviews were conducted with each participant. The initial interview

occurred within the first three weeks of practicum and lasted on average between 30-45

minutes. The initial interview guide can be found in Appendix E. The final interview

occurred within the last three weeks of practicum and lasted, on average, between 60-90

minutes. Each participant responded via email to four researcher-guided journal prompts

sent during the fourth, seventh, tenth, and thirteenth weeks of the semester. Examples of

these guided journal prompts can be found in Appendix F. Feedback from participants

indicated that each journal prompt took between 20-30 minutes, on average to complete.

In an effort to control bias, each participant was asked to complete four member

checks over the course of the semester. Member checks regarding the accuracy of the

data collected and veracity of the emergent themes were sent via email to participants.

Each member check involved the previous research activity. For example: member check

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1, involved the initial interview and the first guided entry prompt; member check 2

involved the data from the guided journal prompt two; member check 3 involved the

guided journal prompt three; and finally member check 4 involved the information

collected and coded from guided journal prompt four and the final interview. For the

entire study of nine participants a possible grand total of 36 member checks were

possible. Of this possible 36 member checks, only 20 were returned by participants. The

majority of participants returned these member checks, with the exception of Red and

Purple, who returned nearly none. No changes or alterations were suggested or desired by

participants regarding the accuracy of the data transcribed or emergent themes. However,

several participants sent responses that were additive to the data already collected. For

example, Orange made statements in the member check for her interview regarding how

angry the practicum process had made her. This additive data were integrated to improve

and further refine themes and elements. Additional efforts to control bias included use of

an epoche, three separate peer consultations with another counselor education doctoral

candidate over the course of the study, memo writing, an audit trail and researcher

journal. Data collection continued over nine months.

Ethical Considerations

The lead investigator secured IRB approval from the University of Northern

Colorado on February 12th, 2014. A copy of the exemption letter can be found in

Appendix A. Because of difficulties with recruitment, after the first two participants, I

sought approval from my committee to offer a fifty-dollar incentive to participants who

would complete the current study. This money originated from my personal funds. The

next seven participants in the study received fifty dollars each in the form of Visa gift

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cards for a grand total of $350.00. The new informed consent can be found in Appendix

C.

Participants’ confidentiality was maintained by following the ethical

considerations section outlined in Chapter III. All participants signed and received a copy

of the informed consent paperwork before they engaged in the study. The informed

consent can be found in Appendix B & C. Copies of these informed consent documents

are kept in a locked file cabinet in my research advisor’s office. All responses from

participants were recorded with the color pseudonym the participant selected.

Participants’ identities and contact information are known only to my research advisor

and me. All audio recordings and emails from journal prompts were erased once

transcribed. At the conclusion of my dissertation process, both hard copies and

electronically saved files on a portable data device will be secured and will be accessible

only to my research advisor and me.

Data Analysis

The constant comparative method of data analysis allowed for the data to be

analyzed as it was collected. Emerging themes were Drawn directly from the data

through the use of incident-by-incident coding and memo writing. As a theme began to

coalesce, it was being compared with other emergent themes and each new piece of data.

There were four basic steps in the data analysis for this study. The specific steps are

described below were adapted from the works of Boeije (2002) and Charmaz (2006) and

detailed in Chapter III. Although data analysis for this study were guided by these

authors work, unique modifications were made by me to satisfy the needs of this study.

Data analysis involved the following four steps: (a) within item comparisons within a

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single data piece (e.g., interview, journal prompts, and member checks.); (b) between

item comparisons between data pieces of the same type (e.g., initial interviews with

students, second journal prompts, etc.); (c) across comparison between themes from

different types of data (e.g., final student interviews with guided journal prompts.); and

(d) connect comparisons between different themes, foundational models, and creating

connections.

Throughout the data analysis these steps lead to refinement of the semi-structured

interview questions and guided journal prompts. Modifications to semi-structure

questions were recorded in the research journal as suggested by memo's written during

data analysis. For example, as conflict with others in practicum began to emerge early to

mid-semester the line of questioning was more deeply explored with each participant to

examine stress, anxiety, and coping elements (if present) and the individual participant’s

perception of the emotive and cognitive elements of their experience.

Consistent with the constant comparative process themes were combined,

separated and re-categorized to best represent the experience of the participants.

Prolonged engagement was achieved through this process as data analysis and refinement

took 11 months. Thematic saturation was achieved when no new or additive material was

uncovered during the data collection and analysis period. As the study wound down to its

end, new data served to strengthen already existing categories, themes, and elements.

More specifically, saturation was achieved when no new information was noted in the

within/between and connect/across data analysis processes.

Table 2 presents the three categories and 16 themes explicated in the next section.

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Table 2

Categories and Themes of the Current Study.

Categories Themes

Sources of Anxiety Anticipatory Anxiety and Fear

Meeting Obligations Outside of Practicum

Interpersonal Conflict

The Live Supervision Environment

Feedback

Modifiers and Influencers Practicum Social Environment

Need for Perfectionism

Trait Anxiety

Previous Experience

Coping Strategies Support

Effective Supervision

Positive Attitude Change

Self-Care

Blaming

Catharsis

Foreclosure or No Coping

Categories are meta-groupings of broad concepts, experiences and perspectives

experienced by all participants; themes are more distinct and significant elements or

derived meanings experienced by most participants. Finally, elements are relevant

perspectives or experiences common to some but not all participants. Elements are

further elaborated on for each theme.

Sources of Anxiety

Five of the 16 themes and supporting elements in this first category detail the

nature of the stress or anxiety participants’ perceived in practicum. The themes

represented were participants’ explanations for a range of perceived threat; at one end of

the range were minor concerns and the other end of the range consisted of the most direct

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perceived threats to their overall experience and positive performance in practicum. It is

important to note that the intensity with which each of the following themes in this

category were reported varied among participants, with most reporting a moderate to high

level of stress and anxiety.

Anticipatory Anxiety and Fear

The first theme describes participants’ experience of the phenomenon of

anticipatory anxiety and fear. The participants reported the primary source of anxiety and

fear was the anticipation of a specific event in practicum, particularly, the first time such

an event was to occur. For example, for most participant’s anticipation of the first live

client session resulted in the greatest degree of anticipatory anxiety and fear, followed

closely by receiving post-session feedback on that first session. The anticipatory process

created anxiety, and for some participants, a very real fear; one akin to terror. Anxiety

was defined by participants as a heightened state of worry and overwhelming concern.

Many participants reported this anxiety resulted in cognitive interference which was

nearly all consuming. Fear was experienced somewhat differently from anxiety in that it

was overwhelming, pervasive and intense and was associated with the fear of failure and

embarrassment for not performing well enough. Unique to this theme was also the initial

dissipation of intense anxiety and fear after the feared event. The dissipation typically

leads to a temporary sense of relief and in some cases an almost giddiness. Participants

experiences and perceptions of anxiety and stress for the duration of practicum were

qualitatively different (e.g., less than) than those encountered related to the first session

or first post-session feedback. This theme had three associated elements: working with

clients, feedback, and evaluation. For example, Blue noted, "I was super super super

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nervous before seeing my first client." Many of the participants echoed Blue's sentiment.

Amethyst writing in her journal prompt noted:

The first instance of felt stress for me [was] meeting my first client.

Having practiced with my familiar classmates the intake session, I was not

prepared for how different of an experience it would be to meet someone I

had never met before, a client, in a counselor role. The stress built as I

took my client to our designated room, as I was pretty caught off guard by

my stressed reaction to meeting this person in the waiting room.

Aquamarine acknowledged the additional anxiety about being the last student in her peer

group to see a client:

This was my first client and I was moved to the end of the list again for

clients. As we were having a hard time getting clients, and I was

busy/tired, I sort of lost it at the end of class on Wednesday.

Other participants commented on this anticipation being stressful and anxiety provoking,

however, less so than some of their peers, such as Green who reported: “It's going to be

exciting, I'm going to finally not be sitting in a class but sitting with a client" and Pink

who added, "So, this is finally going to happen, I'm going to sit in that chair and be a

counselor for the first time, it's so very cool.

As noted earlier, many participants experience a dissipation of their anxiety and

fear after their first session or first post-session feedback. For many, these feelings were

replaced by a huge sense of relief. Purple summed this reaction up best when he reported,

"Hey, I lived through that after all (laughter), I don't know what I was so worked up about

in the first place." Amethyst echoed this sentiment when she said, "Thank god I lived

through that (laughter), it was just too scary."

With respect to post session feedback, it's important to note that it was the

anticipation of receiving feedback, not the actual feedback that provoked anxiety. This

was best exemplified by what Orange wrote in her journal entry:

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I was so scared by going in to get my first comments from the group. I had

no idea what they would say or what they would say about me. I felt this

real sense of Dread. I was convinced that they would wonder why I had

thought I could ever do this in the first place.

Orange went on to describe later that she felt a huge sense of relief after her feedback

session was over. Orange echoed other similar responses by saying, "I was so relieved, it

was nowhere near as bad as I thought it would be."

Meeting Obligations Outside

of Practicum

This theme described participants’ feeling of being "stretched too thin," as Green

stated to be able to have the time and energy to meet the multiple obligations of

practicum and life. The perception or sense of being stretched was experienced across

and within participants’ cognitive, social, emotional, spiritual and familiar roles.

Participant's reported feeling increased anxiety and stress (e.g., pressure, obligation)

especially when any aspect of their academic, professional or personal lives were

perceived to have suffered as a result of them feeling pulled in multiple directions.

Typically, participants expressed regret that they felt they gave so much time, energy and

focus to practicum that they had little to nothing left for their family or work. For

example, Pink stated,

I was so worried I would not have time for the kid's stuff. …I have a

family outside of practicum and so switching gears from taking care of

kids, to my family, to try to be able to manage to be able to be present

with my family. And that switching gears creates a lot of anxiety. I was

afraid they would suffer.

Amethyst also acknowledged how she perceived her work suffering because of the

emotional demands of practicum. Amethyst remarked, "I would go to work and make

mistakes, ya know? I was always just so emotionally Drained away." Green also stated,

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"I was scared of missing something with my kids... I just don't want to be so out of it

because of prac." Most participants described their concerns related to external

obligations with a moderate amount of distress, as if they were in a ‘Catch-22’, caught in

the anxiety and fearfulness related to the ‘cost’ of their practicum experiences while

anxious and fearful to engage behaviors that could relieve their anxiety and fearfulness.

Red comment supports this notion, she said, "I have to devote all this time on practicum,

I know some things are not going to get done."

Interpersonal Conflicts

This source of anxiety came from the acute events surrounding interpersonal

conflicts and the lingering (negative) emotional valence perceived to influence future

interactions with peers, doctoral students, and professors. Participants varied in their

reports of the source, nature and intensity of interpersonal conflicts. There were also

differences in intensity regarding the source of the conflict. For example, the anxiety

reported was often more intense when it involved a doctoral student or professor than it

did with a peer. Of course this difference in intensity would make sense as professors

more so than doctoral students are responsible for the evaluation of participants in

practicum; participants often saw doctoral students as advanced peers, rather than

experts, like faculty. Oftentimes the nature of these conflicts involved the participant's

perception of power and control. For example, questions like, Who is in control? The

professor or doctoral students? were often expressed in passing. It was often the case that

participants would downgrade the importance of feedback that was experienced as hurtful

from doctoral students due to their "incompetence." For example, Orange described an

ongoing conflict with a doctoral student supervisor, "I felt like she [the doctoral student]

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didn't know what the hell she was doing and she's in charge of me. I know she didn't like

it when I would challenge her. She just seemed to never let it go. “ At other times

conflicts between peers would involve the perception of differences in knowledge and

skills performed. This would create a sense of competition for some participants and

would lead to comments such as the following from Green, "she is just such a big damn

know-it-all, always telling us what to do and speaking first in class time." Another

example was when Blue commented about another peer, "I thought I would scream if I

had to hear her talk about what a great job she did with her client again."

Occasionally, the anxiety stemmed from observing or knowledge of conflicts with

others and how those conflicts were or were not resolved. These conflicts may have their

origins in practicum or previous classroom relationships. For example, Blue spoke about

an ongoing conflict with a peer giving her feedback:

I wish we just had more than one peer giving us feedback, because I don't

know about the person giving me feedback. I'm just concerned about my

person because we're really, really different. I think there have been some

concerns with [Blue’s peer] just even being in the program. They had a

couple of run-ins with friends of mine in other classes. She is just not a

very nice person.

Another example of this conflict was when Purple said, "I had a bad experience

with one of our doc's in another place and it was hard to trust her here." Finally,

Red also mentioned this when she said the following about another peer in her

practicum, "She's nuts, she was so crazy and had a meltdown in a class I had with

her, I plan on having as little to do with her as possible."

The Live Supervision Environment

The source of anxiety in this theme directly relates to participants experiencing

the live supervision environment. Participants recalled increased stress and anxiety to

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being observed and recorded during counseling sessions. The live nature of the

observation was viewed as high stakes and that there was little to no room for error.

Participants comment on the fear and Dread of making a mistake in real time that would

irreparably harm their client, the mistake being memorialized on tape to be replayed and

criticized at a later date. Several participants believed they would be harshly judged or

picked apart by the observers. For example, Aquamarine stated, "The live supervision

thing would freak me out a lot. I just kept thinking about what they were thinking about

me." Pre-occupation with the one-way mirror and video camera was common for

participants and was coupled with the feelings of potential threat, condemnation,

judgment by others in the practicum and not being able to defend one’s performance.

Orange noted the omnipresence of the one-way mirror when she stated, "I always knew it

was there, I could always hear them back there."

Typically, anxiety reported regarding direct observation tapered off in intensity as

the practicum progressed. Some participants stated an appreciation for the live

supervision format. As Green stated, "I'm comforted by the live supervision set up

because all though it's nerve racking sometimes, I always know that there is someone

right there with me watching and giving consistent feedback." The feelings of Dread and

anxiety had morphed into a feeling of support and comfort; participants’ focus shifted

from the self to the other. The reduction of anxiety was also expressed by Pink as she

described becoming more accustomed to the one-way mirror, "I felt like it was a non-

issue once I actually got started in session and was focused on the client."

An additional element of this theme centered on the immediate feedback given to

participants, either during mid-session breaks, or at the conclusion of their sessions.

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Participants described a range of experiences and perceptions from feeling overwhelmed,

to ambushed, to inundated. Amethyst's statement exemplifies many participants’

perceptions,

As soon as I would come out of session everybody would be waiting for

me and just staring at me. It was kinda overwhelming for me. Seven

different people and what they all thought was a lot of information to take

in at once.

This sense of being overwhelmed by the potential chaos, expectations and flood of

information was common among participants. As Purple stated, "It scared the hell out of

me to round the corner and see all those people sitting there waiting for me."

Feedback

This theme describes the anxiety and stress experienced by participants while

receiving feedback, both formally and informally, from all sources. Participants

specifically noted concerns regarding the quantity, quality, and veracity of the feedback

as well as their emotional responses to the process and content. The content in this theme

does not address the integration of feedback and or the displaying of counseling skills per

se, but rather centers on perceived nature of the feedback and participants’ emotional

reactions to it. Emotional reactions that included, but were not limited to: experiencing

feedback as confusing or vague and or questioning the motives of the sender.

Participants’ emotional reactions often resulted in extended periods of anger, frustration,

distain related to feedback. As Orange stated, "I was so upset, it ruined my weekend, it

[the critical feedback] was all I could think about." Also echoed by Aquamarine's

statement, "The feedback from everyone was I did a lousy job, I could see them struggle

to have something nice to say, it haunted me for the rest of the week."

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Most participants described confusion associated with how feedback was given

and received. Often times the confusion seemed to emanate from the dichotomous

thinking common to beginning students in practicum. For example, Amethyst said, "She

[her supervisor] said not to ask questions the week before and now this week I'm

supposed to ask questions!" Pink also commented on this, when she said:

It always felt like [the doctoral student] would say one thing to me, and

then when I questioned it would say something else in front of Dr. [the

professor's name]. It wasn't until practicum was almost over that I was

able to really understand she was saying the same thing.

Another example when Purple wrote, "[the doctoral student] just kept saying that I wasn't

present in the room. What the hell does that mean?"

The second element involved anger and or frustration expressed by feedback

received on the student's part. This feedback was often times received as being personal

and or attacking in nature than other feedback was. Orange spoke about this a great deal,

"I've never been so pissed off about anything in my life. Who the hell does she think she

is telling me that I am being cold and uncaring in the room?" Orange went on to report

that she felt like this feedback she received from a peer was "unfair" because it did not

have anything to do with her professionally. This student would remain preoccupied with

this feedback for several weeks during practicum. Aquamarine would also discuss this

saying, "I just felt like what she said was about me as a person and that is none of her

damn business. It still bothers me even though it's [the practicum] all over."

Modifiers and Influencers of Anxiety

The second major category describes those aspects that seemed to modify or

influence, either positively or negatively, the stress and anxiety experienced by

participants. As stated earlier, stress is defined as a signal that requires attention from the

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person experiencing it. In this category of themes, the reader will see how participants

sought to increase or decrease the strength of this stress signal.

Practicum Social Environment

Social interactions, as a whole, between and among all the members of practicum

group seemed to influence the nature and quality of participants’ stress and anxiety.

Participants described a relatively safe and supportive environment, which often

decreased levels of anxiety or they described a relatively unsafe and non-supportive

environment which often increased participants’ anxiety. Participants described a safe

and supportive practicum environment as one in which there was esprit de' corps, where

everyone was working towards the shared goal of being successful. Feedback was

delivered and received in a productive manner, peers assisted others and there was little

to no over competition among students. Hot Pink’s comment exemplifies this

perspective, "I feel very safe in prac. I don't know where this idea came from, but I

thought that prac would be an experience where I would be judged and that made me

extremely nervous going in." Pink would also comment on this sense of safety, "I would

get to this place where I would love to go in and see everyone, I think I'll miss the people

I meet in prac the most." Purple also made several comments along this theme, "I knew

when she [the doctoral student] had something difficult to say to me it was not about

being mean or hurtful, it was what I needed to hear at that time." This theme corresponds

with the coping strategies theme described later in this chapter as participants articulate

the critical nature of positive emotional support from their peers, doctoral supervisors and

faculty during practicum. Additionally, supportive and safe practicum environments also

involved a high degree of mutual respect, professionalism, and trust. Purple spoke about

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some of these elements in group supervision, "It was really cool that people listened to

me about what I thought about my client's issues, I think I just assumed that no one

would really care what I thought."

In contrast, an unsafe and non-supportive practicum environment often seemed to

intensify participants’ stress and anxiety. Sometimes this negative or unsafe environment

was due to conflict between two members of practicum other times it was due to the

behavior of an individual or competitiveness. Participants provided numerous examples

how prior conflict between peers contributed to practicum environment feeling unsafe

and non-supportive. Hot Pink related the following: "Two members of the prac had a

huge Dramatic childish fight and it impacted the entire prac and I just don’t trust them."

Also, due to the lack of interpersonal connection and tension, participants in unsafe

practicum environments often experienced disrespect, hostility, and self-silencing.

Orange describes how she felt in group supervision, "Everything I said was wrong. So, I

remember thinking, what the hell is the point? I'm just going to shut up." Green

experience was during group supervision:

One student tends to be the know it all and can make the rest of us feel put

down sometimes. I asked our professor a question on a topic we were

discussing and on which we had differing opinions. The student proceeded

to answer the question, which was frustrating because I wanted our

professors' opinion, not hers. I didn't address it because I didn't want to

appear rude and I don't like confrontation.

Finally, Red addressed this concern when she said the following about another peer, "She

was just so mean with her feedback, I felt like she didn't really like me and that's what

came through loud and clear."

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Need for Perfectionism

Many participants described the need for their performance in practicum to be

perfect at all times. A lack of perfection would signal to participants a threat that perhaps

they would fail this session, or even that they did not belong in the counseling profession.

Perfection, for many participants meant that they had passed a certain session, or

experience and that they belonged as a counselor. This belief would lead to increased

levels of stress and anxiety. As this belief would diminish, over the course of practicum,

the corresponding anxiety generated would also lessen over time. Participants seemed

initially to be unaware or oblivious to the unrealistic demands they placed on themselves.

There were many examples of this repeated throughout the data. Pink stated this

sentiment best when she said during her initial interview when discussing her

expectations for her performance, "It has to be perfect, or else what am I doing here?"

referring specifically to the counseling skills she was expected to demonstrate.

As the practicum progressed, for the most part, the expressed need for

perfectionism was reduced as well. In her final interview, Pink again commented on

perfectionism, "I know now it was dumb to think I had to be perfect, that perfect doesn't

happen, it was just this idea in my head that it had to be that way, " Blue also said, "I

don't know why I thought I had to be super counselor, it was a dumb idea (laughter)."

Letting go of this over-arching need for perfectionism often overlapped with the theme in

the coping strategies category below of attitude change. However, unlike the attitude

change theme below, which was much more global, the reduction of perfectionism, for

most participants, was much more specific in the data in that it lessened over time and

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that it became more about "...letting myself off the hook..." as Green would later write

when she questioned her need for her performance to be perfect.

Trait Anxiety

This theme describes the natural level of stress and anxiety experienced by

participants in general. This modifier tended to be relatively stable throughout practicum;

in so much as highly anxious participants tended to report higher levels of anxiety, and

less anxious participants reported lower levels of anxiety experienced overall. This

expression of this theme was deeply associated with the idiosyncratic nature of the

participant and less so their experience of the external environment. This theme is unique

in that degree of trait anxiety individually experienced by participants held at a relatively

stable level over the course of practicum, in contrast to the often evolving nature of the

other themes in this category. Examples of this include several participants’ self-

reflective statements; Hot Pink's remarked, "I know that about me, I am a really anxious

person."; Green who said, "That's what I always do. I worry about things a lot.” and

Red’s report; "I'm a freak, I am anxious and scared all the time (laughter)." Examples

exist in the data of other participants who have different trait anxiety, exemplified by

Purple when he stated, "Yeah, I think I'm pretty mellow, things don't bother me for long."

Another example is when Pink stated, "I'm just not that anxious of a person, I can't hold

onto it for long."

Previous Experience

This theme centered on the level of experience working with other people in

professional helping settings such as counseling. Included in this theme were not only

experiences working in the helping professions, but experiences in taking part in

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counseling as well. Having more experiences to Draw upon tended to reduce the stress

and anxiety experienced. An example of Drawing on this previous experience is the

following that Pink wrote:

I'm used to working with clients in a setting that are very reluctant to share

personal information. So there is more work for me to do as far as building

rapport, but the clients I worked with today it's just that I didn't have to

work as hard it was much more natural for me to connect with them much

more easily.

Another example is when Green contextualized feedback she received relative to her

work in counseling, "I've done my own work in therapy and so the feedback that I

received from my therapist were similar. So, no there was no shock there (laughter)."

Purple also provides an example of contextualizing and sympathizing with the client from

his own experiences in counseling, when he stated:

I think for me my own personal experiences being on the other side of the

therapy chair and receiving therapy and having those feelings of this is

very scary and it's scary to be vulnerable and talk about these things I

think that has helped me prepare for practicum.

Finally, Red supports the content of previous participants’ statements related to previous

experience when she observed, "It seemed to me like the people who have worked doing

this kind of stuff before seem more at ease about the whole thing."

Coping Strategies

This third and final category contains seven themes that describe the experiences

and perceptions in which participants coped with stress and anxiety practicum. Although

specific use of and frequency of using these coping strategies varied among individual

participants, all participants reporting using each of these coping strategies at least once

during their practicum experiences.

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Support

This was the most common theme in this category. The data were filled with

multiple examples of the importance participants placed on having support from others.

This theme had four elements, or sources of support: family and friends, peers, doctoral

students, and professors. As Hot Pink said, "I just know she cared about me, I felt

supported by her." Although it was difficult for participants to define the exact

mechanisms that lead to feeling supported (e.g., overt statements from supervisors or

peers, displays of empathy from supervisors, specific accommodations related to

participants’ concerns). Speaking of her significant other Orange said, "I just know he is

a huge support for me." Also Blue recounted a peer whom she had grown close to in

practicum, "She was just such a huge support for me. I don't think I could have done this

without her." The experience and necessity of support was nearly omnipresent in the data

and overlaps, to some degree, with the coping strategy theme presented below that

describes ‘good’ supervision practices. However, this theme is much broader and

involves support given from multiple sources and beyond the support expressed within

the supervision dynamic.

For example, Pink spoke about how important the support she received from

family helped her cope in practicum, "My husband was such a help in always being there

for me and letting me know that I really could do this, I couldn't have done this without

him." Blue noted the importance of peer support when she wrote:

I had a positive, supportive experience with a peer after my first session. I

was very upset because I felt like I did a very poor job and it was not what

I had anticipated. The feedback I got from my supervisors was that it

wasn't great as well. One of my peers made me feel better when she came

to me and told me how supportive and warm I was to my client and that

she would have been very comfortable had she been the client. She said

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my client could tell that I cared about her. It was very helpful to have

some positive feedback and to know that the session wasn't a total failure.

Finally, an example of support from doctoral students is in the following quote from

Amethyst, "she always smiled when she saw me and would always tell me what a good

job I was doing, it felt great to see her."

Effective Supervision

This coping strategy theme centered on appropriate and effective clinical

supervision practices and how this experience helped to relieve participants’ stress and

anxiety experienced during practicum. This theme had two elements, building trust and

rapport, and structure. As mentioned previously, the element of building trust and support

overlapped with the theme of support above. However, specific to this theme, building

trust and rapport, a supportive relationship was used to help facilitate the supervision

relationship. An example of this trust and rapport building during supervision is what Hot

Pink wrote about her interactions with her supervisor:

I have been struggling with self-confidence and my supervisor always has

the best feedback for me. She was the first person to tell me that she would

like me to be her counselor. She is genuine in her feedback and responses

and I feel supported to succeed by her. Her constructive feedback is

always packaged in a way that allows me to hear it, receive it, and use it. I

think it is important to have a supportive supervisor in your prac otherwise

it will be a very lonely hard process.

Increasing the trust and rapport developed during supervision was foundational to begin

the process of learning, evaluation, and integration of new skills vital to the practicum

experience. Purple echoed the importance of having a positive, supportive and genuine

supervisor, he said, "It was like she just assumed I was going to be great at this

(laughter)." And Green extended the importance of positive supervisor interactions

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noting, "I felt like with Dr. [professor's name] it wasn't about screwing up, it was about

what I can do better."

The second element is providing adequate structure for the supervision process.

This structure allowed participants to cope better with stress and anxiety because they

understood the expected process of practicum supervision. Structure and predictability

created a sense of safety that was repeated experienced by participants and expressed

throughout the data. Green wrote about experiencing safety from the structure provided

during in live supervision. He reported,

I was stressed that I was unsure how to navigate the therapy session and

my supervisor was able to immediately provide further insight and

understanding of what is going on in the therapy room. This creates space

for discussion on ways in which I can effectively work with the client.

Having an experienced supervisor has been incredibly helpful for gaining

a deeper understanding and conceptualization of therapy as a whole.

Having the ability to have these conversations with a supervisor allows for

further insight on ways I can help the client better next time. Processing

the therapy sessions with my supervisor is incredibly helpful and stress

relieving as a counselor in training, as it provides a solid sense of direction

for future counseling sessions.

Blue also comment on the critical nature of structure during supervision, "I knew when I

meet with her that I had to have things I wanted to work on and at least three things I did

well in this last week. There was no guessing about what supervision would be like with

[a doctoral student]." Pink also reported in her final interview, "It was great to always

know what was expected of me in our supervision times."

Attitude Change

This theme dealt with the conscious decision of participants to internally change

their attitude or belief about a specific issue or difficulty as a way in which to cope with

the stress and anxiety generated. An example of this was cited previously when Green

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wrote about "deciding to let myself off the hook" with regard to her need for

perfectionism. However, unlike freeing oneself from the need for perfectionism, this

attitude change theme was much broader and more global having to do with multiple

sources of stress and anxiety.

For example, Amethyst discussed how she had felt overwhelmed by practicum

going into the weekend and stated, "I just decided to let go of it and take the weekend off,

that switch helped tremendously, I wasn't going to let it bother me." Another example of

a change in attitude as coping was when Purple described observing another student's

first client, "I thought what the hell, if he survived it, I could do it too, that helped a lot."

A third example of this attitude change was when Pink stated, "My feedback was that I

blabber too much, so I decided not to be freaked out about it, I was going to work on it

and that it was going to be ok."

Self-Care

Second to the importance of support from others, this theme of self-care seemed

to be present frequently in the data as well. All of the participants discussed their

relationship to and use of self-care strategies at some point during the study. This theme

had three elements: avoidance of self-care, planned and executed self-care, and emergent

self-care. This first element of avoidance of self-care involved a dichotomy of

acknowledging self-care was important while simultaneously discounting the personal

use of self-care strategies, typically because of a lack of time and or energy. Blue

provided the most salient example of this experience, "I'm trying to learn to take time for

myself, but I'm a single mom and that never happens (laughter)." Red also stated, "I know

I'm supposed to do things to take care of myself, but really, who does that? not me

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(laughter)." Another aspect of this element involved participants making plans to engage

in self-care activities that ended up never happening over the course of practicum. Hot

Pink stated part of her self-care plan was to do more Yoga and go to the gym. However,

an example of this element is apparent in the following statement she made during her

last interview, "Yeah I was supposed to do Yoga (laughter), that was never going to

happen (laughter) and it didn't either, I mean really? Yoga?"

The second element is planned and executed self-care. These were self-care

strategies that were pre-planned from the beginning or even before practicum began, to

which participants made and kept a commitment to following through with. This element

had some overlap with the modifier of previous experience reported earlier, in that as

Pink said, "I know from experience I need to do this or it will just make everything

harder than it needs to be." An example of planned self-care strategy involved Purple

reported that he had gone back to counseling before practicum started because as he said,

"... I know it will help me immensely." This planned element of self-care was also

distinctive from the first element in that it was followed through with and reported as

successful during the final interview.

The third and final element was emergent self-care, which was self-care strategies

that emerged for participants spontaneously during the course of practicum and helped

better cope with stress and anxiety. Orange described an example of this when she

reported, "I decided that I would leave all my bags and junk in the car one day so I could

walk in the house and greet my dogs properly, that seemed to help a lot." Other examples

of this emergent self-care would deal with the concept of taking a break or allowing

oneself to just take a moment. An example of this was when Amethyst wrote, " I took the

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time to go outside and feel the sun and soak up the warmth and close my eyes and just

reset."

Blaming

The theme of blaming involved participants coping with the stress and anxiety of

practicum by deflecting the responsibility for their own performance and actions onto

someone other than themselves. In this way the participant was able to seemingly protect

their own ego and beliefs about self-efficacy. This theme overlapped with several of the

concepts presented in the sources of anxiety category theme of feedback, specifically

anger and frustration expressed around vague or confusing feedback received. Every

participant in the study used blaming as a coping mechanism at least once during the

study. However, for two participants in particular, Orange and Aquamarine, blaming

seemed to be employed as a primary coping mechanism throughout practicum. The

experiences or behaviors in this theme almost always involved the blaming of supervisors

as opposed to peers, especially doctoral student supervisors.

Orange statement provide a clear example of this behavior as she comments on

her doctoral student supervisor’s feedback,

She is just a bitch, it has nothing to do with what I'm doing, she hates me

and she is the one that doesn't know what the hell she is doing, she keeps

criticizing me as being cold and aloof, but she can't give me an example of

it, it's because she doesn't like me.

Aquamarine’s blaming was focused on her peers. She noted, "They dislike me because

they’re jealous of me and so they say anything they can to bring me down." Aquamarine

reported in her final interview, "They're just a bunch of dumb bitches (laughter), so of

course they had nothing good to say about me, I'm just glad it's over."

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Another less emotionally charged example of blaming was related to the

perceived credibility of the supervisor whether it was his or her availability or degree of

knowledge. Commenting on her professor Hot Pink said, "She is so busy, I don't know

that she really sees me in session enough to know what she is talking about." Green

recounted her experience of a doctoral supervisor, "She is really new to all of this and I

don't think she always understands exactly what she is talking about." And added despite

this she (Green) did enjoyed working with this particular doctoral supervisor. Finally,

Purple echoed these sentiments when he described a peer’s feedback, "It was hard to take

it seriously because she doesn't know what she's doing any more than I do (laughter)."

Catharsis

The theme of catharsis describes participants’ perceptions and experiences of

emotional reactions to the stress and anxiety generated from practicum. Catharsis had two

basic elements, helpful catharsis (e.g., behaviors and believes that aided coping or was in

some way soothing) and unhelpful catharsis (e.g., behaviors and believes that often

provided little to no relief of stress or anxiety and sometimes increased the negative

emotions present). Purple statement of needing "to blow off steam." captured the

sentiment of many participants.

An example of helpful catharsis was described by Blue in her final interview, "I

had two or three times maybe were I would sit in the parking lot and just cry... It was a

relief to let it go after a bad day, but was also usually exhausted after too (laughter)." A

second example of helpful catharsis is reflected in Red's comment during her initial

interview, "I've already cried a lot after practicum, but it always seemed to make me feel

better." Hot Pink also described behavior in which participants allowed themselves an

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emotional release, "I went in the bathroom and just feel apart for like 5 minutes, and I put

myself back together and went back."

Unhelpful catharsis was experienced by many as emotions and experiences in

which they felt out of control, angry and scared. Amethyst wrote, "... I just got so damn

freaked out and I couldn't seem to stop it, in the end I just felt worse, like sick and

nauseous all over." Orange experienced anger and vulnerability, "I would get so damn

angry and cry and then be angry that I let them make me cry."

Foreclosure or No Coping

The final theme in this category was the conscious decision to shut down or not

engage in any coping what so ever. This anti-coping strategy was effective for some

because they felt the threat of not becoming successful in practicum as so real that ending

participation in practicum in general, and coping with stress and anxiety, seemed like the

only solution. It is important to note that this theme differs from the coping strategy

described above in which participants sought a brief respite to experience their emotions

and return to practicum. Unlike those strategies the theme of foreclosure represents the

perceptions and experiences of participants who sought a permanent ending of any

coping for an extended period of time. This was exemplified by Orange during her final

interview, she remarked, "I decided to fuck it and fuck them, I just went through the

motions the last three weeks of prac." Aquamarine reaction was less profane, yet held a

similar sentiment, she said, "I just wanted it to be over so badly, I would just nod and say

yes to whatever they said."

This concludes chapter IV wherein the themes of the current study were

presented. The 16 themes from the current study were further broken down into three

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categories': sources of anxiety, modifiers and influencers of anxiety, and coping. In the

next section, chapter V, these themes will be discussed as they relate to the current

research literature. Finally, chapter V concludes with the presentation of the emergent

theory itself.

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CHAPTER V

DISSCUSSION AND RECOMMENDATIONS

If you're going through hell, keep going.

-- Winston Churchill

In the current study I explored the potential tenets of a grounded theory Drawn

from an examination of masters' students’ experiences with stress and anxiety in a live

supervised individual counseling practicum. This chapter presents a summary, synthesis,

and exploration of the data in light of the professional literature followed by a description

of the emergent theory. The chapter concludes with a discussion of known limitations,

implications and directions for research in counselor education and training.

Anxiety and Stress

Trainee anxiety has long been the focus of research in counselor education. From

the early days of counselor education researchers focused on trainee’s anxiety relative to

the developmental model, cognitive complexity, adult learning, and perspectives of the

supervisor (Loganbill et al.., 1982; Hogan, 1964; Arbuckle, 1965). Rarely did researchers

then or now directly examined trainee’s anxiety from the perspective of the trainee

(Barbee et al.., 2003; Edwards & Patterson, 2012; Hill et al.., 2007; Woodside et al..,

2007). The rationale for the present study, in part, was meant address the imbalance in

perspectives. Trainees’ experiences, including anxiety, stress and coping, were examined

from the perspective of trainees as their voices and experiences were honored and

documented. Participants articulated numerous sources of anxiety relative to their

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experience in a live practicum. Their individual and collective experiences and

perceptions described anticipatory anxiety and fear, meeting obligations outside of

practicum, interpersonal conflicts, the live supervision environment, and feedback.

It is important to note that this category of anxiety and stress overall fits with the

lifetime work of Lazarus and Folkman (e.g. Lazarus, 1966; Lazarus & Folkman, 1984;

Folkman & Lazarus, 1985; Folkman & Lazarus, 1988; Lazarus, 1999; Folkman &

Moskowitz, 2000; Folkman & Moskowitz, 2004). Specifically, that it is the individual's

perception of the stress that is paramount. In this way it is the individual’s perception,

belief, and experiences of stress that is appraised to rise to the level of an anxious

reaction. In other words, what was appraised as stressful for one participant would not

necessarily be apprised as stressful for another. In this way the appraisal model of stress,

anxiety, and coping runs parallel with the qualitative research tradition in that both find

the perceptions and experiences of the individual as the most important. In this category,

it was the individual perceptions of anxiety and stress from participants that serves as

foundational for the following themes.

Anticipatory Anxiety

For many students the anticipation of certain events during practicum triggered a

great deal of stress and anxiety. For example, the anticipation of events such as: the initial

meeting with a client, the initial supervision session, and or the initial live peer/faculty

post session feedback evoked feelings of fear, worry, Dread, panic and or the desire to

flee. Participants would often report that the source of this anticipatory anxiety would

involve some combination of the unknown regarding expectations, a sense of low-self-

efficacy, and or being evaluated. Participants noted, few if any, strategies or behaviors in

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which they engaged to address these emotions. At the conclusion of these signpost

events participants’ stress and anxiety did not disappear, but was Dramatically decreased.

The counseling research literature makes scant mention of this phenomenon of

anticipatory anxiety for counseling practicum students. The research literature that does

make mention of this anticipation is either theoretical (Loganbill et al.., 1982;

Stoltenberg, & McNeill, 2010) or anecdotal (Hacberth & Dinkmeyer, 1991; & Fitch &

Marshall, 2002) in nature.

To gain a fuller understanding of this phenomena I examined the constructs of

anticipatory anxiety outside of the counseling profession, in related behavioral health

professions such as nursing, psychology and medicine. The training experiences and

related anticipatory anxiety for the participants of this study (e.g., counselors-in-training;

CITs) and beginning nursing students experience are similar enough to provide a

sufficient analogue. Both CITs and beginning nursing students spend their initial training

in an academic classroom and then transition to live supervised practice with real clients

(patients) in real time with real outcomes. The primary difference between the two groups

is that CITs do not initiate, monitor, and complete intimate examinations and sometimes

painful (e.g., injections or Drawing blood) threatening procedures upon their

clients/patients. The expectation to and experience of performing live, in front of peers,

instructors, and patients in a high stakes learning environment appears to be the primary

precursor for anticipatory stress and anxiety, similar to the findings of the current study.

For example, Beck and Srivastava (1991) conducted a study involving 94 subjects

and examined nursing students’ perceptions of stress and anxiety in clinical practice.

Beck and Srivastava reported student nurses experienced a great deal of fear, stress, and

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anxiety correlated with the anticipation of attempting new clinical techniques for the first

time on medical patients. The causes of this anticipatory anxiety experienced by these

nursing students was similar to the anticipatory anxiety experienced by the current study's

participants. Both groups cited the reasons for this anticipatory anxiety having to do with

uncertainty surrounding their level of skills in combination with being evaluated live by

an instructor. These researchers also found that this anticipatory anxiety would be

considered great enough of a psychological threat that many nursing students would

question their career choice in wanting to become nurses in the first place.

The nature of the training environment and supervisory feedback seemed to

impact student nurses’ experiences of anticipatory anxiety. Cook (2005) found

anticipatory anxiety increased in a sample of 229 student nurses when they were

observed by an unsupportive and uninviting instructor or evaluator. Cook defined this

unsupportive and uninviting evaluator as someone who would make a series of

derogatory, negative, and sexist statements to their nursing students. These student nurses

noted this in a self-evaluation questionnaire that was designed to capture anxiety

provoking events in their live training. Also in the nursing training literature, Cheung and

Au (2011) demonstrated that anxiety increased before nursing students demonstrated a

clinical procedure for the first time when they were prompted with anxious, rather than

supportive stimuli prior to attempting the procedure. Cheung and Au used a video clip of

the 2003 SARS epidemic in Hong Kong as the anxious stimuli, whereas the calm stimuli

showed a video tour of the hospital many of the students would be placed at later in their

training. Similarly, Teixeira, Kusumota, Pereira, Braga, Gaioso, et al.. (2014) found the

mere presence of an instructor increased anticipatory anxiety. They found nursing

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students, who were observed live by an instructor during the first performance of a

procedure, reported markedly increased levels of anxiety when compared to nursing

students whose performance was videotaped without the presence of an evaluator. These

findings of these studies seem to indicated that anticipatory anxiety may be part of the

experience of live professional training and yet the question remains what differentiates

individual trainee experiences. Moscaritolo (2009) seems to provide partial insight to this

question through the results of her qualitative examination of nine nursing students. She

found humor, mindfulness exercises, and supportive mentors reduced the amount of

reported stress and anxiety around beginning clinical work for the first time. Her

findings may have implications for counselor educators.

Meeting Obligations Outside

of Practicum

As noted in Chapter IV participants reported having greater than usual stress and

anxiety from managing family, work, friends, and other academics after the time and

energy spent on practicum. This phenomenon of balancing school, family, and career is

common among graduate students (Hyun, Quinn, Madon, & Lustig, 2006; & Fairchild,

2003), however, the stress and anxiety experienced during practicum was different in that

it involves prolonged and undulating stress and anxiety over an extended period of time.

There is no counselor education research literature that focuses on the stress and

anxiety of juggling multiple roles during practicum. However, the general counseling

literature presents a larger body of research that deals with wellness of counselors. This

wellness research often references counselors taking time to take care of themselves in a

multitude of ways so as to fend off burn out, clinical fatigue, and to increase empathy

(Lawson, 2007). Wellness is defined as a state of being, integrating mind, body, and spirit

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for the purpose of achieving and maintaining personal health and balance (CACREP,

2009). The maintenance of personal health implies counselors will address and improve

management of all the stressors, including meeting obligations outside the role of

counselor (e.g., training and practice). Within the wellness literature, there are many

research studies focused on wellness for counseling students.

Generally, the counseling literature notes that CITs struggle to balance their

graduate school/home/professional lives, most notably, CITs at the beginning of their

programs of study. Myers, Mobley, and Booth (2003) conducted a large study of 263

graduate students at various different academic levels. They noted entry level students

experienced markedly less overall wellness scores than exiting masters or doctoral

students. Myers, Mobley, and Booth describes these entry level students as having

already completed several classes, including practicum. These entry-level counseling

students scored lower on balancing work, leisure, and meaningful relationships than the

other more experienced students, which is consistent with the findings in the present

study. Roach and Young (2007) also studied wellness for 204 masters counseling

students. This study looked at wellness during three periods of students counseling

preparation, beginning, middle, and end. Roach and Young found that counseling

students at the midpoint of their training rated the importance of having healthy

relationships with friends and family as most important and the most difficult to maintain.

Roach and Young offer no explanation as to why CIT's at the mid-point of their training

would make this report regarding healthy relationships outside of reinforcing the idea that

self-care and wellness are important for all CIT's. Roach and Young also offer no

explanation of whether or not the CIT's in their study are involved with practicum in the

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mid-point group. However, it is not unreasonable to assume that these mid-point CIT's

make these statements due to more academic stress and possibly taking part in the

practicum experience.

Interpersonal Conflicts

Participants in the current study articulated the critical contribution interpersonal

conflicts made to their experiences of stress and anxiety. Additionally, a majority of

participants noted the negative and long lasting impact on practicum peer relationships at

the time of the conflict as well as a lingering mistrust and discomfort over the course of

the semester. Throughout the study participants revisited the feelings and beliefs evoked

in the aftermath of these conflicts. By focusing on the CITs’ experience, the current study

revealed the multiple conflicts experienced among and between practicum students and

their peers, supervisors, and professors. No research studies were located that addressed

the stress and anxiety directly generated from these interpersonal conflicts within a live

supervised individual practicum. Interestingly, two trends in the literature were located

that that relate to CITs’ stress and anxiety. The following literature presents the

perspective of the faculty related to student retention/gatekeeping and supervisor conflict

rather than the CITs’ perspective on their experiences of CITs’ in practicum.

Baldo, Softas-Nall, and Shaw’s (1997) landmark article recounted a student

dismissal that was, in part, based on lack of competent relationships with peers and

clients. Although Baldo et al.. are silent on the nature or degree of the dismissed

student’s specific interpersonal conflict with his peers, one may rightly infer that because

the student’s behavior was described as "incompetent and unethical" his “inability to

attend to clients and classmates, lack of warmth, and lack of empathy” (p. 420) was a

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source of stress and anxiety for the dismissed student and his practicum peers. The Baldo

et al.. article is relevant because it documents the serious nature of interpersonal conflicts

as a source of stress and anxiety, albeit an extreme case and causes one to ask, what about

cases of student conflict that do not rise to this same level of severity?

The literature recounting students’ problematic behaviors requiring attention, but

not leading to dismissal also provides support of stress and anxiety as a result of

interpersonal conflict among peers in a live supervised practicum. Brown (2013)

conducted a qualitative content analysis of programs gate keeping and remediation

polices. Among Brown's findings were various definitions of counseling students'

problematic behaviors. These problematic behaviors that relate to the current study

include: an inability to interact with peers and trainers in a professional manner, an

inability to control her or his anger and frustration when interacting with others,

consistently making false and or deceptive statements, and often being disrespectful

especially in regards to multiculturalism. Although Brown defines problematic behaviors

in CIT's from an entire program perspective and not limited to only practicum, her

findings run parallel with the findings of the current study. Along this line of thought,

Rosenberg, Arcinue, Getzelman, & Oren (2005) conducted an exploratory study that

sought student's reactions to these identified problematic students. Rosenberg et al..

created a survey and used a convenience sample of 129 students (87 masters and 42

doctoral psychology students) from their own counseling program. Their findings were

remarkable similar to the findings of the current study with regards to conflicts between

counseling students. More specifically, the students in the Rosenberg et al.. study felt

great concern over these specific problem behavior student’s interpersonal skills with

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others, worked towards avoiding contact with this student, and expressed discomfort

being in academic settings with this identified student.

Doctoral student supervisors and supervising professors were also a source of

interpersonal conflict resulting in stress and anxiety for participants. The interpersonal

conflicts most often were related aspects of the supervisor/supervisee’s working alliance

between supervisee and supervisor (Bernard & Goodyear, 2014). For example, Ladany

(1995) conducted a study and surveyed 123 supervisee participants who were receiving

supervision as a part of their clinical training in practica and internship. Ladany wrote the

following about conflicts in the supervision working alliance:

Irrespective of the degree to which trainee and supervisor agree on the

tasks and goals of supervision, the stronger their emotional bond, the less

role conflict experienced by the trainee. This finding lends support to the

notion that counselors and supervisors with a strong emotional bond (i.e.,

mutual caring, liking, and trusting) are more likely to work through and

resolve conflicts, thus decreasing the extent of past and potential role

conflict (1995, p. 230).

Although Ladany was studying role conflicts between supervisee and supervisor, he

defined these role conflicts as having to do with power struggles within the supervisory

working alliance. Ladany's results support and confirm the current study's findings that

when supervision relationship was negative in nature it acted as a source of stress and

anxiety for participants.

Live Supervision

Environment

The next source of stress and anxiety emergent in the current study was related to

the live supervised environment, its structures, and common practices. The two elements

reported in this source of anxiety involved being observed live and the immediate

feedback process. Researchers have addressed this issue of the live supervision

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environment generating stress and anxiety. However, this research has been anecdotal

and or told from the counselor educators’ point of view (Costa, 1994; Mauzy & Erdman,

1997; Mauzy et al.., 2001; Wong, 1997).

Few research studies have focused on the stress and anxiety specific to the live

supervision environment itself. For example, Koltz and Feit (2012) conducted a

qualitative phenomenological study into the lived experiences of three live counseling

pre-practicum students. The Koltz and Feit (2012) study was parallel to the current study

in that these students were followed throughout their semester long pre-practicum

experience as well. Many of Koltz and Feit's findings are confirmatory with the current

study's findings related to stress and anxiety in a live supervised environment. Koltz and

Feit wrote:

Anxiety seemed to be a primary emotion that emerged for participants.

With the emergence of anxiety, participants found that they had a variety

of questions come to their mind regarding live supervision. Many of the

questions stemmed from unfamiliarity with the idea of live supervision, as

well as the changes that they were feeling as a person. However,

participants found that their self-talk was extremely instrumental when

"being the counselor" to manage their anxiety. Participants found that their

anxiety was particularly high during feedback (both feedback during the

session, as well as the feedback session at the end) (2012, p. 9).

Although the anxiety reported by Koltz and Feit was similar to the anxiety experienced

by the current study's participants, the intensity was much less. One explanation for the

difference in the intensity reported probably stemmed from the current studies

participants working with actual clients, while Koltz and Feit's participants worked in

skill development role plays with other students.

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Feedback

Finally, the last source of stress and anxiety uncovered during the current study's

findings involves receiving poor, vague, and contradictory feedback from peers, doctoral

supervisors, and professors in practicum. This source of stress and anxiety is the mirror

image of the supportive, warm, and collaborative feedback which is identified as a coping

resource later in the study. For example, Trepal et al. conducted a qualitative study with

25 practicum supervisees in which they were asked to describe critical incidents in

supervision (2010). The authors found among the negative themes that emerge in their

study were comments made by these students regarding unprofessional, unsupportive,

and even sabotaging feedback they received from site supervisors. Furthermore, in

regards to vague feedback resulting in increased anxiety, Arthur and Gfroerer (2002)

surveyed 45 master level interns in a couple's and family internship and found support for

this notion. In their study participants reported that when feedback was provided for them

in written form in was much more concrete, less vague than verbal feedback, and created

less anxiety for them. However, it is also interesting to note as an aside, that students

reported that having a permanent reminder of their sometimes poor performance of skill

would also generate anxiety of its own.

From the supervisor and trainer perspectives Jacobs, Huprich, Grus, Cage, &

Elamn et al.. (2011) recommend from their anecdotal experiences as practicum and

internship supervisors to always ground feedback in behavioral and program specific

anchors to avoid supervisee confusion and anxiety. Furthermore, Lehrman-Waterman

and Ladany define quality feedback anecdotally in supervision as being " feedback that is

systematic, timely, clear, and balanced between positive and negative statements" (2001,

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p. 168). Finally, Abbott and Lyter (1998), in a survey of 43 social work field supervisors,

found that effective critical feedback given to supervisees must be supportive in nature to

help integrate new information, that harsh language can create extreme anxiety in the

supervisee. Abbot and Lyter also recommended from their findings that supervisors

understand that supervisees may require time to properly understand and integrate critical

feedback, that the process for most supervisees is not instantaneous.

The Context of Anxiety and Stress

The individual experiences and perception of trainees were bounded by the

context in which each participant studied, learned and lived. Participants in this study

identified numerous aspects of their broader context that were believed to influence,

positively or negatively, the degree of intensity of anxiety and stress experienced in a live

supervised practicum. These aspects included: participants’ perceptions of psychological

safety, expectations for personal perfectionism, trait anxiety, and previous experience

dealing with emotionally charged situations.

Psychological Safety

within Practicum

The first context in which participants stress and anxiety was influenced was the

perception participants had in regard to their psychological safety in the group dynamic.

Participants’ perception of their psychological safety was heavily influenced by and

highly related to interpersonal conflicts referenced in the earlier sections. The experience

of psychological safety seemed to be influenced by type (e.g., mistrust, distrust or trust)

and intensity of trust, the quality of the working alliance and safety with doctoral student

and faculty supervisors. There is a great deal of research in the supervision literature that

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supports the importance of trust in the working alliance between supervisor and

supervisee.

The importance of supervisors and instructors directly dealing with psychological

safety within the group for practicum students was the subject of an anecdotal theoretical

article written by Kaiser and Ancellotti (2003). The authors wrote the following

concerning students safety in group interactions and supervision:

Instructors also recognize the need to normalize the anxiety felt by those

students who privately believe that they are the most anxious and

inexperienced members of the group. When students acknowledge their

anxiety and as they interact with one another over time, they are able to

express uncertainty and concerns about their performance. Open

acknowledgment, in itself, creates a supportive and cohesive culture of

mutuality, support, and respect. The high degree of challenge encountered

during the practicum makes the support factor the most discussed and

analyzed aspect of the practicum process (2003, p. 297).

Creating this environment of openness in which supervisees express their anxiety in a

supportive environment confirms the current studies theme regarding reduction in the

anxiety experienced when participants felt psychologically safe within the group.

Regarding psychological safety in supervision, Borders, in her landmark article

recommending research concerns in counselor education, stated that conflicts in

supervision and supervisee resistance are often directly related to weaknesses in the

supervision relationship (1989). Specifically, Borders states that a strong supervisory

relationship must be grounded in trust, respect, rapport, and empathy. Although Borders

was speaking anecdotally and commenting on counselor education research at the time,

her assertions about avoiding conflict are parallel with the current study's findings that a

negative or positive supervisory relationship can increase or decrease the anxiety

experienced by the participant.

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Need for Perfectionism

The second aspect of the context of stress and anxiety involved participants’

relative need for perfectionism. The current study's findings indicate many participants’

increase desire or need for perfectionism relative to their in-session performance in

practicum was associated with increased levels of stress and anxiety and vice versa.

Ganska et al.., 2015 explored practicum students’ and the desire for perfectionism. These

researchers found an apparent link between CITs need to be perfect (e.g., error free)

perfectionism and the supervisory working alliance, particularly along the dimension of

attractiveness. Although the Ganska et al.. student makes no mention of stress or anxiety,

it seems quite likely that supervisees who perceived a strong alliance with their

supervisor would experience less stress and anxiety due to an agreed upon view of the

supervisees’ performance. Arkowitz (1990) presented a theoretical and anecdotal

exploration of CITs’ desire for perfection. Arkowitz's theorized CITs’ perfectionism

would like lead to decreased self-efficacy, rigidity in thought and practice, and perhaps

increased anxiety. The findings in the present study provide some support for Arkowitz’s

hypotheses.

Generally, empirical research suggests intense levels of perfectionism, especially

maladaptive perfectionism, lead to increased reports of stress and anxiety (Zhou, Zhu,

Zhang, & Cai, 2013; Shafran & Mansell, 2001; Hewitt, Caelian, Flett, Sherry, Collins, &

Flynn, 2002; Flett, Endler, Tassone, & Hewitt, 1994; & Dunkley, Blankstein, Halsall,

Williams, & Winkworth, 2000.). Zhou et al.. define maladaptive perfectionism as:

Adaptive perfectionists tend to set themselves realistic rather than

unreachable standards, emphasize achieving success rather than avoiding

failure, and their behaviors are underlaid by positive reinforcement On the

other hand, behaviors of maladaptive perfectionists are strengthened by

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negative reinforcement, as they seek to avoid or escape personal failure,

tend to set unrealistically high standards, and are Driven by a fear of

failure.

Although the current study does not use these terms in the reported data or its subsequent

codes and themes, these concepts of adaptive and maladaptive perfectionism fit well as

parallels to several participants’ reported need for perfectionism. Zhou et al.. went on to

find that in their study of 426 college students maladaptive perfectionism positively

correlated with increased reported anxiety.

Trait Anxiety

The third aspect of the general context of stress and anxiety experienced by

practicum students involve the individual differences between reported trait anxiety. No

research was identified that dealt directly with levels of high or low trait anxiety for

students in practicum. However, the general trait anxiety research does confirm the

findings within this theme. Trait anxiety is defined in its simplest terms as the relative

level of anxious responses that is typical for a person to express (Endler & Kocovski,

2001). This finding aligns itself with the theme trait anxiety in the current study as

individual students self-identified the typical level they would tend to respond to

situations anxiously, whether high, medium, or low. This definition of trait anxiety is an

individualistic reasonably stable set of responses across time (Endler & Kocovski, 2001).

Previous Experiences with Emotionally

Charged Situations

The fourth and final theme of the context which influences the stress and anxiety

generated, involves participants’ individual levels of experience working with

emotionally charged situations and people. Adult learning theory states that previous

experiences are often integrated by adult learners into their current learning, which in turn

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helps to guide and lessen the level of anxiety experienced (Merriam, 2001; & Mezirow,

1996). More specifically, many of the characteristics of adult learners identified by

Knowles, also acts as support for this theme (1984). Especially with regards to adult

learners becoming increasingly independent, intrinsically motivated to learn, and

becoming more problem-focused than subject-focused.

The counselor development theoretical literature adds confirmation to this theme

regarding previous experiences. Counselor development acknowledges that when CIT's

recycle through the developmental process again (e.g., internship, another modality of

practicum, advanced practicum training) the CIT experiences markedly less stress and

anxiety then when they originally went through the process (Stoltenberg, & McNeill,

2010; Ronnestad, & Skovholt, 2003; & Loganbill et al.., 1982).

The general anxiety research literature also offers support and confirmation for

the concept of previous experiences moderating and reducing anxiety. For example,

Norriss and Murrell (1988) surveyed 234 adults regarding their anxiety after a recent

flood in Kentucky and found that those adults that had been through a flood previously

reported significantly less anxiety than those who had not. Also, Humphris and King

(2011) surveyed 1024 university students from the United Kingdom and found that

previous positive experiences going to the dentist lead to lower reported levels of anxiety

during yearly check-ups than subjects that had negative or no previous experiences.

Finally, Beckers and Schmidt (2003) surveyed 184 psychology freshman and found that

anxiety from learning and performing new skills with an unknown computer program

was greatly reduced by even a modest amount (less than 20 clock hours) of previous

computer experience.

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Coping

The third category of themes involved coping strategies used by participants in

practicum. There are seven components to this category: support, effective supervision,

positive attitude change, self-care, blaming, catharsis, and foreclosure or no coping. The

pertinent literature is reviewed in regards to each of these coping themes.

Support

Of all the forms of coping uncovered by the current study, emotional support was

the most commonly reported coping strategy in the counseling practicum research

literature, regardless of its source (peers, supervisors, family, and friends) (Costa, 1994;

Barbee et al.., 2003; Mauzy & Erdman, 1997; Mauzy et al.., 2001; Schauer et al.., 1985;

Daniels & Larson, 2001; Edwards & Patterson, 2012; Bowman et al.., 1978; & Abel, et

al.., 2012). In a qualitative study of the emotional needs of family counseling practicum

students, Edwards and Patterson (2012) noted:

Positive contact with peers in the practicum setting has a critical influence

on trainees' clinical training. The finding that talking with peers-in-

training about personal issues can produce positive emotions makes

intuitive sense: Clinical colleagues can be a resource for support, both

professionally and personally. For example, trainees can discuss each

other's frustrations and disappointments after a difficult session, when

clinical work is negatively impacting their personal lives, and when

personal lives are impacting their clinical work (p. 693).

The Edwards and Patterson quote above is consistent with the findings of the current

study related to coping and the need for positive emotional support.

The importance of social support from peers, family, and friends in coping with

the stress and anxiety of practicum has theoretical and empirical support from the

appraisal model of stress and coping put forth by Lazarus and Folkman (Lazarus, 1966;

Lazarus & Folkman, 1984; Folkman & Lazarus, 1985; Folkman & Lazarus, 1988;

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Lazarus, 1999; Folkman & Moskowitz, 2000; Folkman & Moskowitz, 2004).

Specifically, the social focused scheme from the appraisal model is consistent with the

findings involving support found in the current study (Folkman & Moskowitz, 2004;

Lazarus & Folkman, 1984). Both the appraisal model and the coping theme of support

involves the seeking out of support, comfort, and sometimes guidance from others as a

major way in which students work towards decreasing their stress (Folkman &

Moskowitz, 2004; Lazarus & Folkman, 1984).

Theoretical support for the coping theme of emotional support from the counselor

developmental model also is present in the literature. Stoltenberg and McNeill (2010)

wrote the following about the importance of facilitative interventions for beginning

counseling trainees:

These interventions are intended to communicate support to the supervisee

and encourage development. Praise, reinforcement of appropriate

demonstrations of skills, careful and attentive listening, and other

indications of appreciation of and consideration for the supervisee are

particularly useful at this time (p. 67).

This concept of facilitative interventions and their importance are also evidenced by the

coping theme of support in the current study. This facilitative and supportive stance by

supervisors towards their supervisees are also reflected in the next coping theme of

effective supervision.

Effective supervision

Effective supervision was identified as a coping theme uncovered in the current

study. Effective supervision theme echoes many of the best practices put forth by the

Association for Counselor Education and Supervision (ACES) in 2011. These include,

but are not limited to fostering trust and rapport, supportive feedback, and organizational

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and structural understanding of what supervision will be. Participants in the present study

identified effective supervision practices and noted that they were aided them increasing

their ability to coping in practicum.

The supervision literature has many empirical examples of the strength and

structure of the supervisory alliance from the supervisees’ point of view (Hart & Nance,

2003; Steward, Breland, & Neil, 2001; Worthington & Roehlke, 1979; Efstation, Patton,

& Kardash, 1990; & Ladany, Ellis, & Friedlander, 1999). The commonality reported in

these research studies were similar to the findings of the current study with regards to

supervisee preferences for supervisors being supportive and providing structure. These

research findings are also consistent with the developmental model which emphasizes

increased structure early in the live practicum experience as an aid to reduce supervisee

anxiety.

Positive attitude

The research literature often refers to a positive attitude as positive emotional

change (Folkman & Moskowitz, 2004). Positive emotions are defined by Folkman and

Moskowitz as a change in emotional state from fear and anger into joy and hope that

helps the individual better cope with the stress in their lives, especially chronic stress

(Folkman & Moskowitz, 2004; Folkman & Moskowitz, 2000; & Folkman & Moskowitz,

1997). The majority of professional literature describing positive emotional change and

coping has been conducted by Folkman and Moskowitz and involves individuals living

with the ongoing stress of chronic, life threatening disease such as AIDS and cancer.

Although participants in the current study did not have chronic terminal diseases, they did

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have prolonged engagements with the high levels of stress and anxiety in practicum, as

well as feelings of a loss of or little control over events in their lives.

A number of researches (Beer & Moneta, 2012; Spangler, Pekrun, Kramer, &

Hofmann, 2002; & Frederickson & Joiner, 2002) examined positive emotional change in

college students and noted it was the greatest overall predictor of positive, problem-

focused, adaptive coping. Although these studies did not involve coping with the stress

and anxiety of a counseling practicum, they did examine stress and coping related to

academic performance. Similar to the present study, all of these studies involved

honoring the students prospective (Beer & Moneta, 2012; Spangler et al.., 2002; &

Frederickson & Joiner, 2002).

Self-Care

The next coping theme focused on the knowledge and use of self-care strategies

by participants to cope with the stress and anxiety of live counseling practicum. Many

studies were found that focused on improving student self-care through a variety of

different techniques and interventions. For example, teaching biofeedback techniques to

graduate counseling students (Chandler et al.., 2001); training graduate counseling

student’s mindfulness, meditation, and yoga (Schure et al.., 2008); and finally, teaching

spirituality as a part of wellness development to counseling trainees (Myers & Williard,

2003). Yager & Tovar-Blank (2007) summed up the sentiment of promoting self-care in

counseling students and counselor education:

Counselor educators can reduce their own anxiety and discomfort as self-

care models by reminding students that wellness is always a process, not

an outcome. Perfection is not the goal of wellness. We may have ideal

outcomes, but these are rarely, if ever, attained. As humans, we will

inevitably find that we do not achieve the ideal balance between the

personal, social, physical, spiritual, and occupational domains of our lives.

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What we can address successfully are moment-to-moment adjustments

approximating a wellness-focused balance (page 146).

This notion of both the importance and constant adjustments fits well with the findings of

the current study.

Blaming, Catharsis, and Foreclosure

or No Coping

The final three themes in the category of coping are related to each other in that

they fit the research literatures definition of avoidance or maladaptive coping.

Maladaptive coping strategies are defined as negative and ineffective responses to stress

and anxiety that include: an inability to take responsibility for one's own actions which

often leads to blaming others, avoiding or denying that the stressful or anxious process

exists, and inappropriate outbursts of negative emotion typically anger at others or

towards the self (Aldwin & Revenson, 1987; Gardner, Archer, & Jackson, 2012; &

Ireland, Brown, & Ballarini, 2006). Furthermore, there are indications in the research

literature that suggests maladaptive coping is connected with psychopathology and or

personality disorders, especially borderline personality disordered traits (Gardner et al..,

2012; Ireland et al.., 2006; Arslan, 2010; Bijttebier & Vertommen, 1999; & Cukrowicz,

Ekblad, Cheavens, Rosenthal, & Lynch, 2008).

No research could be found that directly relates the concepts of maladaptive

coping with counseling students in practicum. However, in the supervision literature a

common subject for investigation involves supervisee resistance (Bernard & Goodyear,

2014). Although maladaptive coping and supervisee resistance in supervision are not the

same construct they do share many similar elements (e.g., supervisee reluctance to

integrate feedback, emotional vulnerability dichotomous thinking, focus on the self to the

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exclusion of the client or peers). Supervisee resistance is often a normal and healthy

reaction on the part of the supervisee to fear and perceived psychological threat that often

times is transient in nature (Bernard & Goodyear, 2014). Whereas maladaptive coping is

suggested by the research literature as more of a permanent pattern of ineffective coping

in the person's life. In all likelihood the coping themes of blaming, catharsis, and

foreclosure or no coping can probably be defined for the individual student as being

either maladaptive coping, supervisee resistance, or some combination of both.

An Emergent Theory of Anxiety, Stress, and Coping

It is widely known that the elements of a good theory include a parsimonious

description of general concepts, relationships, process, predictions, and verifiabilities.

Describing an emergent theory from research data presents its own set of conditions and

perils. As I considered the data before me, I knew I wanted to go beyond the more

mechanistic descriptions provided by Corbin and Strauss (2008) and found that the

writings of Charmez (2006) reflected and confirmed my research intentions and further

solidified my researcher stance. Particularly her following statement:

The acts involved in theorizing foster seeing possibilities, establishing

connections, and asking questions. Grounded theory methods give you

theoretical openings that avoid importing and imposing packaged images

and automatic answers. How you practice theorizing and how you

construct the content of theorizing vary depending on what you find in the

field. When you theorize, you reach down to fundamentals, up to

abstractions, and probe into experience. The content of theorizing cuts to

the core of studied life and poses new questions about it (2006; page 135).

Additionally, the development of a theory, at its core, seeks to answer fundamental

questions. Questions like who, what, when, where, how, why and under what conditions.

Sutton and Staw (1995), commenting on the work of other scholars, noted:

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We agree with scholars like Kaplan (1964) and Merton (1967) who assert

that theory is the answer to queries of why. Theory is about the

connections among phenomena, a story about why acts, events, structure,

and thoughts occur. Theory emphasizes the nature of causal relationships,

identifying what comes first as well as the timing of such events. Strong

theory, in our view, delves into underlying processes so as to understand

the systematic reasons for a particular occurrence or nonoccurrence... a

good theory explains, predicts, and delights (page 378).

In the current study I have endeavored to create a theory that answers the ‘who’, ‘what’,

‘how’ and ‘why’. The emergent theory rests on the description of the nature, meaning,

and expectations of the participants’ experiences and their relationship to stress, anxiety,

and coping in the context of a live supervised individual practicum. The ‘who, what, how

and why’ questions are address in each of the three sub-section that follow.

The emergent theory of anxiety, stress and coping in a live supervised, individual

counseling practicum has three basic interconnected concepts: the coping dimensions, the

coping continuum, and coping trajectories. The primary concept in this emergent theory

is an understanding of six dimensions of coping, these include: personal characteristics,

interpersonal characteristics, group interactions, emotions, cognitions, and use of coping

strategies. Each of the six coping dimensions’ focus on a different area participants’ need

to navigate the practicum experience. The second concept in this emergent theory deals

with a continuum of coping effectiveness that further explains and clarifies the

understanding of student's coping in practicum and is directly applied to each of the

coping dimensions named above. This effectiveness continuum is anchored each end by

excellent and poor coping. Finally, the third key concept of this emergent theory

identifies three possible participant trajectory or profiles to help illuminate three

hypothesize pathways participants likely took throughout their coping in practicum.

These three trajectory or profiles represent the different coping levels, at the present time

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they are referred to high, medium, and low. I begin with an explanation and exploration

of the six coping dimensions.

Six Coping Dimensions and

The Coping Continuum

Personal Characteristics. The first coping dimension involves the individual

participants’ personal characteristics and how they helped or hindered coping in a live

supervised individual counseling practicum. Personal characteristics reflect the three

supporting elements for each participant in practicum, they are: level of previous

experiences, ability to receive and integrate feedback, and relative need for perfectionism.

Each of these supporting elements can be further defined using the continuum of

effectiveness of coping. For example, the first element, level of previous experience. At

the excellent coping effectiveness end of the continuum, the participant had multiple

previous experiences to Draw upon when working with clients, peers, and supervisors.

Near the center of the coping effectiveness continuum, the participant possessed little to

no previous experience to Draw upon when working with clients, peers, and supervisors.

Finally, at the poor coping end of the continuum, participants typically had no previous

experience with clients and supervisors and if previous experience or training was present

participants seemed to view it as the only way things should be done.

Interpersonal Characteristics. The second coping dimension are the

interpersonal characteristics students experience in interacting with their peers, doctoral

supervisors, and professors. More specifically, participants populating this dimension

demonstrated varying degrees of intrinsic and extrinsic motivation to learn, a variety of

strategies to resolve conflicts with others, and varying levels of the quality and quantity

of feedback provided to peers. At the excellent coping end of the continuum participants

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tended to report high degrees of intrinsic motivation to learn, effectively resolved

conflicts with others, and consistently provided supportive, insightful appropriate

feedback to peers. Participants who populated the middle of the coping continuum,

typically reported vacillating between intrinsic and extrinsic motivation, engaging

appropriately with peers with whom they have not had hurtful conflicts, and reported

inconsistent provision of supportive and helpful feedback. Participants populating the

least effective level of the coping continuum, reported primarily extrinsic motivations to

learn, reported several hurtful, unresolved and long standing conflicts with practicum

peers (which tended to color future interactions); reported aloof, superior and dismissive

attitudes towards their peers and supervisors, and consistently reported giving peer

feedback that could be characterized as unsupportive and ineffective.

Group Interactions. The third coping dimension, group interactions, involves the

ways in which the individual participants interacted with the practicum group as a whole.

The elements of this dimension involve participants’ attitude, professionalism, sensitivity

to the group dynamic, dealing with the mechanics of the live supervision environment. At

the excellent end of the coping continuum, participants reported a consistently positive

attitude. Other students, doctoral supervisors, and professors mostly likely would report

that they enjoy working with this student. Participants operating at this end of the

continuum reported consistent displays professional behavior (e.g., assist peers,

knowledge of the ethical code), felt consistently safe with regards to the group dynamic,

and consistently reported working effectively with others in the live supervision

environment (e.g., assisting with the fast pace, quickly receiving and integrating

feedback, helpful to others with technology). The middle of the coping continuum was

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comprised by participants who reported struggles to maintain a consistent positive

attitude and professionalism (e.g., desire to ‘cut corners’, not review their previous

sessions) and reported displaying both positive and negative behaviors at various times

during the semester. Also those who comprised the middle of the continuum medium of

coping seemed the most sensitive to changes or vicissitudes in the group dynamic. These

participants’ experiences and behaviors reportedly changed the most with regards to how

safe they report feeling in the group as a whole. These participants also seemed to

experience the most inconsistent success when navigating the mechanics of the live

supervised environment. Finally, participants who resided at the poor end of the coping

continuum, were often cited by their peers (who were also participants in the study) as

toxic or one of the main sources of an unsafe, unfriendly, and unsupportive environment.

These participants typically reported or displayed poor attitudes, unprofessional

behaviors, and cared very little for the overall safety experienced in the group dynamic as

a whole.

Emotions. This dimension describes the emotions participants’ reported

navigating during practicum with regard to coping. Specifically, these participants

believed they had to deal with the intensity and frequency of their negative emotional

states, experiences with catharsis, anticipatory fear, and the level of emotional threat

generated by receiving feedback in a group. Participants at the excellent level of the

coping continuum experience relatively low levels of emotional intensity across nearly all

states (anxiety, stress, fear, anger, and frustration). These participants also experienced

few if any instances of catharsis, anticipatory fear, or threat generated from receiving

feedback. Participants at the midpoint of the coping continuum, experienced wild

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fluctuations in the intensity and frequency of their negative emotions. These participants

also had multiple experiences with catharsis, especially related to anxiety, stress, and

frustration. These participants often report a great deal of anticipatory fear, especially for

signpost events practicum (initial taped client session, initial supervision session, initial

post-session group feedback). These participants at the midpoint of the coping continuum

also inconsistently experience emotional threat when receiving feedback, especially

feedback when it was personal in nature. Finally, participants at the poor end of the

coping continuum experienced high or overwhelming intensity of negative emotions,

catharsis that typically did not offer relief, and consistently experienced high emotional

threat from receiving any type of feedback from any source. At times these participants

reported paranoia regarding constructive feedback received from peers, supervisors, and

professors.

Cognitions. The fifth coping dimension involved the cognitions participants

reported engaging during practicum to deal with coping. These cognitions involve

participants’ need to blame others for their feedback or performance, appraisal of their

own skill level, and ability to be flexible in their thinking especially in regard to point of

view taking. Participants at the excellent coping level, consistently voiced responsibility

for their performance in practicum and did not blame others for constructive feedback.

These participants consistently understood and acknowledge their skill level and

displayed flexibility, complexity, and multiple points of view related to their work (case

conceptualization, receiving feedback, use of supervision). Participants at the midpoint

level of coping were inconsistent with taking responsibly for their performance/feedback

and occasionally blamed the source of constructive feedback. These participants often

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experienced/reported wide fluctuations in the appraisal of their skills as well as

inconsistencies in displaying flexibility, complexity, and point of view taking in

cognition. Participants at the poor end of the coping continuum consistently blamed

others for their poor performance and feedback and frequently discounted or dismissed

all constructive feedback received based on their perception of the source as incompetent.

These participants also appraised their own skills as excellent to sufficient and typically

higher than the feedback they receive would indicate. These participants consistently

demonstrated cognitive inflexibility, dichotomous thinking, and little to no ability to

understand multiple points of view or relativistic thinking. Finally, these students

typically projected a rigid set of beliefs about clients, the counseling process, and the

practicum experience in general.

Knowledge and use of self-care strategies. This final coping dimension

addresses participants’ understanding and use of self-care strategies. Specifically,

whether or not the individual participant perceived self-care as important, to what level

self-care was planned and carried out, and the overall success participants reported in

managing their lives inside and outside of practicum. Participants at the excellent end of

the coping continuum consistently voiced that self-care was important for them to plan

and engage. These participants consistently reported managing work, family, friends, and

practicum through the use of planning and forethought before practicum began.

Participants at the midpoint on the coping continuum reported self-care was something

important only for others, a waste of their time and resources, or as strategies they report

to others but have no intention of actually using themselves. These participants typically

struggled balancing work, family, friends, and practicum effectively. These participants

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occasionally reported neglecting one aspect of their lives being put on hold or being

negatively affected during practicum. Finally, for participants at the poor end of the

coping continuum self-care is rarely used or reported and was described as often

unrealistic. These participants reported a poor balance between work, family, friends, and

practicum, usually with more than one of these aspects being put on hold or negatively

affected. Ultimately, for these participant’s foreclosure on any coping past the middle of

the semester of practicum was often a distinct possibility.

Coping Trajectories

The six coping dimensions describe above as well as how they relate to the coping

continuum are required to understand the present emergent theory yet are not sufficient

alone. The third component of the emergent theory, is required to understand how

students typically move through the practicum experience over the course of their one

semester of live supervised experience. Understanding this element of the theory answers

the ‘How’ question posed at the beginning of this section. The goal of providing basic

trajectories allows the emergent theory to predict potential student coping in a live

supervised practicum. At this point in the development of the theory, it is inappropriate to

comment on the potential success or failure CITs in practicum as it relates to coping,

more data needs to be gather. Yet, considering theoretical underpinnings of the

developmental model and the current data tentative considerations are offered. There are

three coping trajectories proffered from this emergent theory: Effective Coping,

Inconsistent Coping, and Ineffective Coping.

The Effective Coping trajectory is characterized by a CIT who typically remains

within the excellent range of the coping continuum throughout practicum. This is not to

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say the individual remains on this trajectory, rather he or she remains within the excellent

range of coping the majority of the time and makes continued positive improvements in

his/her counseling skills, case conceptualization, ethical decision-making and cultural

competencies. In keeping with the appraisal model of stress and coping, this individual

would mainly be employing problem-focused coping (Folkman & Moskowitz, 2004). As

a part of problem-focused coping this CIT would cope through actively seeking out

stressful and anxiety producing problems and making plans on how best to deal with

them. This CITs appears to self-aware, psychologically minded, relatively free of

psychopathology, demonstrates cognitive flexibility and cultural awareness and have few

concerns related to self-esteem or self-efficacy. This CIT would manage the inherent

ambiguities of counselor training and professional development, including supervisory

feedback and direction. This is not the typical CIT and would likely stand out as more

interpersonally mature and possessing wisdom. In terms of counselor development, this

individual would display behaviors consistent with someone transitioning from Level I

into Level II (Stoltenberg & McNeill, 2010). This CIT would be supportive of peers,

integrate feedback with few difficulties and demonstrate reflective practice. In our

common nomenclature this CIT would pass practicum ‘with flying colors.’

The Inconsistently Effective trajectory is characterized by a CIT who typically

remains within the midpoint range of the coping continuum the majority of their time

throughout practicum. Students on this trajectory struggle with stress, anxiety, and coping

in practicum throughout the previously described six coping dimensions. This CITs

experiences gains and setbacks in their improvements in his/her counseling skills, case

conceptualization, ethical decision-making and cultural competencies consistent with the

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developmental model. This is the typical CIT who typically demonstrates: limited self-

awareness, some psychologically minded insights, occasional displays minor

psychopathology (e.g., anxiety, depression, passive-aggressive behaviors), exhibits

cognitive inflexibility, minor to moderate concerns related to self-esteem or self-efficacy

(specifically related to performance), and occasional cultural encapsulation. This CIT

would struggle with inherent ambiguities of counselor training and professional

development, yet is capable of growth based on integration of feedback and guided

reflection. In terms of counselor development, this individual would display behaviors

consistent an individual at the beginning of Level I. Within the structure of the appraisal

theory, this CIT would be mostly use social-focused coping (Folkman & Moskowitz,

2004). Specifically, this CIT would very often cope through the scheme of seeking out

support from others. This CIT would frequently be supportive of peers, and would

integrate feedback with some difficulties. This coping trajectory differs from the

Effective Coping trajectory in two important ways. First and foremost, the students in this

profile improve in their ability to cope overall as practicum progresses. This

improvement is likely function of the CIT progressing through the counselor

developmental model given typical supports and resources. Second, this trajectory

differs in that it represents the likely coping trajectory of a majority of practicum

students. In other words, this trajectory represents the typical CIT coping pattern.

Finally, the Ineffective coping trajectory is characterized by a CIT who spends the

majority of their time at the poor end of the coping continuum throughout practicum. Not

unlike the effective coping trajectory students, these students are relatively rare in

number, yet their behaviors are immediately evaluated as unproductive by peers and

118

supervisors. Students on this trajectory make few improvements in her or his counseling

skills, case conceptualization, ethical decision-making and cultural competencies. This

CITs appears to lack self-awareness (specifically her or his impact on others), is likely

not psychologically minded, likely demonstrates some form of enduring

psychopathology, is cognitively rigid, struggles with multiplistic thinking and may lack

cultural sensitivity. He or she will most likely demonstrate concerns related to self-

esteem or self-efficacy and struggle to take responsibility for her or his performance.

Within the appraisal model, this CIT would use mainly emotion-focused coping

(Folkman & Moskowitz, 2004). Through the use of emotion-focused coping, this CIT

would be preoccupied with the negative emotions of distress. This CIT seems unable to

grasp the inherent ambiguities of counselor training and professional development,

specifically supervisory feedback and direction. These students are usually avoided and

often described or experience as difficult by peers, doctoral supervisors, and professors.

She or he is likely to display consistently inappropriate professionalism, attitudes, and

behaviors which likely results in some form of formal remediation. In terms of counselor

development, this individual would display behaviors consistent someone entrenched at

the beginning of Level I and would be quite likely to fail practicum requiring her or him

to repeat the experience or be counseled into a new profession. Although students fail and

need to repeat practicum for a host of reasons, the current emergent theory suggests CITs

on this trajectory make up a majority of candidates who fail practicum.

Limitations of the Study

As the current emergent theory is preliminary the theory should be viewed with

caution. In keeping with the nature of theoretical work, as more data and future studies

119

are completed the theory will change and improve in its understanding of how students

cope with stress and anxiety in a live supervised individual practicum.

The primary limitation of this study lies in the recruitment of participants.

Originally this study was designed to Drawn participants from a variety of CACREP

institutions with a live practicum, yet, recruitment was extremely difficult and resulted in

modifications to the original design. For example, many students who choose not to

participate shared that they felt the time commitment for the current study was too

extensive, both in the individual requirements and the time span of the entire semester.

Also several instructors and supervisors, who initially voice a willingness to have their

students invited to participate decided not to grant access to their practica. Although the

reasons for this change of heart are not specifically documented, some supervisors may

have been reluctant to have their students participate given the perception and possible

threat that their instruction and supervision would indirectly be evaluated. Therefore,

given that the sample was Drawn from one institution and many of the participants were

in an intact group, the data, and therefore the findings are potentially limited by the

homogeneity of the participants, social desirability and institutional practices. Yet,

despite the potential limitation, the results of deeply examining participants Drawn from

mostly an intact group did provide insights in to peer relationships that a more

heterogeneous sample would not have provided.

Areas for Future Research

Future studies into this phenomenon will be required to deepen and better

strengthen the current emergent theory. Some possible directions for future research

include using more diverse and purposeful samples from multiple institutions consisting

120

of more diverse participant identities. Additionally, some considerations should be given

to sampling from intact groups to gain the peer to peer perspective. Second, future

research could utilize mixed methodologies, including existing quantitative anxiety and

coping measures, personality profiles and qualitative research tools. Third, it will be

essential to include collateral participants surrounding the student in practicum, including

supervisors, doctoral student supervisors, employers, clients, and family members or

significant others. Finally, researchers will want to consider the screening, admission and

review and retention constructs within counselor training programs because it is likely

that students who populate the Ineffective Coping trajectory are likely struggling in other

areas of their program.

Implications

The current study and emergent theory is important for students, counseling

training programs, counselor educators, and training of clinical supervisors. The first

strength of the current study is that it is the first of its kind to focus on the perceptions

and honors the voices of students in a live supervised, individual counseling practicum.

Although much research has been conducted the vast majority of this research is from the

supervisor or trainer perspective. I believe that this is the only study that not only

attempts to understand this phenomenon but also sought to create an emergent theory

from the student's perspective.

The emergent of stress, coping, and anxiety can help future supervisors and

professors of practicum better understand and predict possible behaviors and ultimate

practicum outcomes of their students. It has been my anecdotal experience working as a

doctoral supervisor within live supervised individual practicums that many of the

121

students who fail practicum do so in part because they have failed to manage their stress,

anxiety, and coping effectively. the current emergent theory represents an important first

step in understanding, possibly identifying, and intervening in the ineffective coping of

students within practicum as well as possibly counselor education programs in general.

Impairment, burnout, and distress have been popular issues for counselors in the

past few years, which is appropriate because it directly effects client care. Shouldn't it be

important that we address counselor distress and how best to cope with anxiety from the

very beginning of the counselor development process? By understanding the coping

process in practicum, it is my belief that we could extend the wellness and self-care

movement in counseling to the very beginning. What better platform to use to impress

upon counselors the importance of self-care and wellness than during their first real test

as counselors?

As the current study progressed it became apparent to me that I would

recommend to counselor education programs that they actively engage in self-care and

wellness strategies with their students. This may be achieved in several ways, including:

the creation and maintenance of formal self-care plans; integrating self-care and wellness

throughout curriculum; and offering or encouraging group activities in yoga,

biofeedback, or relaxation techniques. Also during the progression of the current study I

was struck by how important a modifier for individuals' experience of stress and anxiety

previous experience was. It is with this in mind that I would also recommend a pre-

practicum course in counseling skills. Among other training advantages, this counseling

skills class would give students a sense of familiarity with the process and dynamic of

counseling in a much more controlled and less high-stakes manner. I believe this previous

122

experience for students could possibly greatly decrease the experience of stress and

anxiety.

I believe that in general the better a student copes with anxiety, the more

successful the learning outcomes will be for that student. It is my belief that if we as

counselor educators and supervisors are better able to address the anxiety in practicum

for our students we could improve the retention of the skills and information imparted to

those students. We could not only improve student learning we could enhance the quality

of that learning.

It is my desire that this theory adds to the professional literature as it documents

practicum students’ voice and experiences and informs counselor educators and

supervisors from the perspective of the student. This theory hold the promise of providing

multiple opportunities for the counselor education profession at advance scholarship,

improve instruction, supervision and curriculum with regards to live supervised

individual practicum.

123

REFERENCES

Abel, H., Abel, A., & Smith, R. L. (2012). The effects of a stress management course on

counselors-in-training. Counselor Education & Supervision, 51, 64-79.

Abbott, A. A., & Lyter, S. C. (1998). The use of constructive criticism in field

supervision. Clinical Supervisor, 17 (2), 43–57.

Aldwin, C.M., & Revenson, T.A. (1987). Does coping help? A re-examination of the

relation between coping and mental health. Journal of Personality and Social

Psychology, 53, 337– 348.

American Counseling Association. (2005). ACA code of ethics Retrieved June 1, 2011,

from http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx.

American Institute of Stress. (2010). Effects of stress. Retrieved June 12, 2011, from

http://www.stress.org/topic-effects.htm.

Arbuckle, D. S. (1965). Counseling: Philosophy, Theory, and Practice. Boston: Allyn

and Bacon.

Arkowitz, S. W. (1990). Perfectionism in the supervisee. Psychoanalysis &

Psychotherapy, 8(1), 51-68.

Arthur, G.L., & Gfroerer, K.P. (2002). Training and supervision through the written

word: A description and intern feedback. Family Journal, 10, 213-219.

Arslan, C. (2010). An investigation of anger and anger expression in terms of coping with

stress and interpersonal problem solving. Educational Sciences: Theory &

Practice, 10(1), 25-43.

124

Association for Counselor Education and Supervision. (2011). Best practices in clinical

supervision. Retrieved from http://www.acesonline.net/resources/

Baldo, T. D., Softas-Nall, B. C., & Shaw, S. F. (1997). Student review and retention in

counselor education: An alternative to Frame and Stevens-Smith. Counselor

Education & Supervision, 36(3), 245-253.

Bandura, A. (1956). Psychotherapists' anxiety level, self-insight, and psychotherapeutic

competence. Journal of Abnormal and Social Psychology, 52, 333-337.

Bandura, A. (1977). Self-efficacy: Towards a unifying theory of behavior change.

Psychological Review, 84(2), 191-215.

Barbee, P. W., Scherer, D., & Combs, D. C. (2003). Pre-practicum service-learning:

Examining the relationship with counselor self-efficacy and anxiety. Counselor

Education & Supervision, 43(2), 108-120.

Baumgartner, L. M. (2001). An update on transformational learning. In Merriam, S. B.

(Eds.), The new update on adult learning theory, no.89. San Francisco, CA:

Jossey-Bass.

Beck, D.L., & Srivastava, R. (1991). Perceived level and sources of stress in

baccalaureate nursing students. Journal of Nursing Education, 30, 127-133.

Beckers, J., J., & Schmidt, H. G. (2003). Computer experience and computer anxiety.

Computers in Human Behavior, 19(6), 785-797.

Beer, N., & Moneta, G. B. (2012). Coping and perceived stress as a function of positive

meta-cognitions and positive meta-emotions. Individual Differences Research,

10(2), 105-116.

125

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th.

ed.). Upper Saddle River, NJ: Pearson Education.

Bijttebier, P., & Vertommen, H. (1999). Coping strategies in relation to personality

disorders. Personality and Individual Differences, 26, 847–856.

Borders, L. D. (1989). A pragmatic agenda for developmental supervision research.

Counselor Education & Supervision, 29(1), 16-24.

Bowman, J. T., & Roberts, G. T. (1979). Counselor trainee anxiety during counseling.

Journal of Counseling Psychology, 26(1), 85-88.

Bowman, J. T., Roberts, G. T., & Giesen, J. M. (1978). Counselor trainee anxiety during

the initial counseling interview. Journal of Counseling Psychology, 25(2), 137-

143.

Brown, M. (2013). A content analysis of problematic behavior in counselor education

programs. Counselor Education & Supervision, 52(3), 179-192.

Carkhuff, R. R. (2000). The art of helping in the 21st century (8th ed.). Amhearst, MA:

Human Resources Development Press.

Chandler, C., Bodenhamer-Davis, E., Holden, J. M., Evenson, T., & Bratton, S. (2001).

Enhancing personal wellness in counselor trainees using biofeedback: An

exploratory study. Applied Psychophysiology & Biofeedback, 26(1), 1-7.

Charmaz, K. (2006). Constructing grounded theory: A practical guide through

qualitative analysis. Thousand Oaks, CA; Sage Publications.

Cheung, R. Y. & Au, T. K. (2011). Nursing students' anxiety and clinical performance.

Journal of Nursing Education, 50(5), 286-289.

126

Cook, L. J. (2005). Inviting teaching behaviors of clinical faculty and nursing students'

anxiety. Journal of Nursing Education, 44(4), 156-61.

Corbin, J., & Strauss, A. (2008). Basics of qualitative research. (3rd ed.). Thousand Oaks,

CA: Sage Publications.

Costa, L. (1994). Reducing anxiety in live supervision. Counselor Education &

Supervision, 34, 30-41.

Council for Accreditation of Counseling and Related Educational Programs. (2009).

Standards [Electronic Version] from http://www.cacrep.org/2009standards.pdf.

Council for Accreditation of Counseling and Related Educational Programs. (2011a).

Vision, Mission and Core Values. Retrieved May 1, 2011, from

http://www.cacrep.org/template/page.cfm?id=40.

Council for Accreditation of Counseling and Related Educational Programs. (2011b).

Why Attend an Accredited Program? Retrieved May 1, 2011, from

http://www.cacrep.org/detail/accredited.cfm.

Cowden, P. (2010). Communication and conflict: Anxiety and learning. Research in

Higher Education Journal, 9, 1-9.

Cukrowicz, K.C., Ekblad, A.G., Cheavens, J.S., Rosenthal, M.Z., & Lynch, T.R. (2008).

Coping and thought suppression as predictors of suicidal ideation in depressed

older adults with personality disorders. Aging & Mental Health, 12(1), 149-157.

Daniels, J. A., & Larson, L. M. (2001). The impact of performance feedback on

counseling self-efficacy and counselor anxiety. Counselor Education &

Supervision, 41(2), 120-131.

127

Davenport, J., & Davenport, J. A. (1985). A chronology and analysis of the anDrogogy

debate. Adult Education Quarterly, 35. 152-159.

Dodge, J. (1982). Reducing supervisee anxiety: A cognitive-behavioral approach.

Counselor Education & Supervision, 25, 55-61.

Dunkley, D. M., Blankstein, K. R., Halsall, J., Williams, M., & Winkworth, G. (2000).

The relation between perfectionism and distress: Hassles, coping, and perceived

social support as mediators and moderators. Journal of Counseling Psychology,

47, 437-453.

Edwards, T. M., & Patterson, J. E. (2012). The daily events and emotions of master-level

family therapy trainees in off-campus practicum settings. Journal of Marital and

Family Therapy, 38(4), 688-696.

Efstation, J. J., Patton, M. J., & Kardash, C. M. (1990). Measuring the working alliance

in counselor supervision. Journal of Counseling Psychology, 37, 322-329.

Endler, N. S., & Socovski, N. L. (2001). State and trait anxiety revisited. Journal of

Anxiety Disorders, 15(3), 231-245.

Evans, M. (2010, August 2). Men largely MIA from counseling. Counseling Today,

53(2), 5.

Fairchild, E. E. (2003). Multiple roles of adult learners. New Directions for Student

Services, 102. 11-16.

Falender, C. A., Cornish, J. A. E., Goodyear, R., Hatcher, R., Kaslow, S., Leventhal, G.,

et al.., Grus, C. (2004). Defining competencies in psychology supervision: A

consensus statement. Journal of Clinical Psychology, 60, 771–785.

128

Fitch, T. J., & Marshall, J. L. (2002). Using cognitive interventions with group

counseling practicum students during group supervision. Counselor Education &

Supervision, 41, 335-343.

Flett, G. L., Endler, N. S., Tassone, C., & Hewitt, P. L. (1994). Perfectionism and

components of state and trait anxiety. Current Psychology, 13, 326-350.

Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: Study of emotion

and coping during three stages of a college examination. Journal of Personality

and Social Psychology, 48(1), 150-170.

Folkman, S., & Lazarus, R. S. (1988). The relationship between coping and emotion:

Implications for theory and research. Social Science & Medicine, 26(3), 309-317.

Folkman, S., & Moskowitz, J.T. (1997). Positive psychology states and coping with

severe stress. Social Science & Medicine, 45(8), 1207-1221.

Folkman, S., & Moskowitz, J.T. (2000). Positive affect and the other side of coping.

American Psychologist, 55(6), 647-654.

Folkman, S., & Moskowitz, J.T. (2004). Coping: Pitfalls and promise. Annual Review of

Psychology, 55, 745-774.

Frankl, V. E. (1959). Man’s search for meaning. New York, NY: Simon & Shuster.

Frederickson, B.L., & Joiner, T. (2002). Positive emotions trigger upward spirals toward

emotional well-being. Psychological Science, 13(2), 172-175.

Friedlander, M. L., Keller, K. E., Peca-Baker, T. A., & Olk, M. (1986). Effects of role

conflict on counselor trainees’ self-statements, anxiety level, and performance.

Journal of Counseling Psychology, 33(1), 73-77.

129

Gardner, K. J., Archer, J., & Jackson, S. (2012). Does maladaptive coping mediate the

relationship between borderline personality traits and reactive and proactive

aggression? Aggressive Behavior, 38, 403-413.

Glaser, B., & Strauss, A. (1967). The discovery of grounded theory. Chicago: Aldine.

Gnika, P. B., Chang, C. Y., & Dew, B. J. (2012). The relationship between supervisee

stress, coping resources, the working alliance, and the supervisory working

alliance. Journal of Counseling & Development, 90, 63-71.

Granello, D. (2004). Supervision of group work: A model to increase supervisee

cognitive complexity. The Journal for Specialists in Group Work, 29(2), 159-173.

Hackbarth, S., & Dinkmeyer, D. (1991). Adlerian concepts in the counseling practicum.

Individual Psychology, 47(2), 266-271.

Hahn, W. K., & Molnar, S. (1991). Intern evaluation in university centers: Process,

problems, and recommendations. The Counseling Psychologist, 19(3). 414-430.

Hart, G. M., & Nance, D. (2003). Styles of counselor supervision as perceived by

supervisors and supervisees. Counselor Education & Supervision, 43, 146–158

Heckman-Stone, C. (2004). Trainee preferences for feedback and evaluation in clinical

supervision. The Clinical Supervisor, 22(1), 21-33.

Hendrickson, S. M., Veach, P. M., & LeRoy, B. S. (2002). A qualitative investigation of

student perceptions of live supervision in genetic counseling. Journal of Genetic

Counseling, 11(1), 25-50.

Henschke, J. A. (2011). Considerations regarding the future of anDragogy. Adult

Learning, 22(1). 34-37.

130

Heppner, P. P., & Roehlke, H. J. (1984). Differences among supervisees at different

levels of training: Implications for a developmental model of supervision. Journal

of Counseling Psychology, 31(1), 76-90.

Hewitt, P. L., Caelian, C. F., Flett, G. L., Sherry, S. B., & Collins, L., & Flynn, C. A.

(2002). Perfectionism in children: Associations with depression, anxiety, and

anger. Personality and Individual Differences, 32, 1049-1061.

Hill, C. E., Sullivan, C., Knox, S., & Schlosser, L. Z. (2007). Becoming psychotherapists:

Experiences of novice trainees in a beginning graduate class. Psychotherapy:

Theory, Research, Practice, Training, 44(4), 434-449.

Hogan, R. A. (1964). Issues and approaches in supervision. Psychotherapy, Theory,

Research, and Practice, 7,139-141.

Holloway, E. (1995). Clinical supervision: A systems approach. Thousand Oaks, CA:

Sage Publishing.

Honberg, R., Kimball, A., Diehl, S., Usher, L., & Fitzpatrick, M. (2011). State mental

health cuts: The continuing crisis, a special report from NAMI the national

alliance on mental health. Retrieved from http://www.nami.org/mwg-

internal/de5fs23hu73ds/progress?id=OpZkq9EKct&dl

Humphris, J., & King, K. (2011). The prevalence of dental anxiety across previous

distressing experiences. Journal of Anxiety Disorders, 25(2), 232-236.

Hyun, J. K., Quinn, B. C., Madon, T., & Lustig, S. (2006). Graduate student mental

health: Needs assessment and utilization of counseling services. Journal of

College Student Development, 47, 247–266.

131

Ireland, J.L., Brown, S.L., & Ballarini, S. (2006). Maladaptive personality traits, coping

styles and psychological distress: A study of adult male prisoners. Personality and

Individual Differences, 41(3), 561–573.

Imel, S. (1994). Working with adult learners (Digest No. 154). Columbus, OH: ERIC

Clearinghouse on Adult Career and Vocational Education. Retrieved from ERIC

Database. (ED377313).

Ivey, A., Ivey, M., & Zalaquett, (2014). Intentional interviewing and counseling:

Facilitating client development in a multicultural society. Bellmont, CA. Brooks

Cole.

Jacobs, S. C., Huprich, S. K., Grus, C. L., Cage, E. A., Elman, N. S., Forrest, M. N., et

al.., Kaslow, N. M. (2011). Trainees with professional competency problems:

Preparing trainers for difficult but necessary conversations. Training And

Education In Professional Psychology, 5(3), 175-184.

Kaiser, D., & Ancellotti, T. (2003). A family counselor practicum based on a deliberate

psychological education model. Counselor Education & Supervision, 42(4), 286-

301.

Kagan, N., & Kagan, H. (1990). IPR: A validated model for the 1990’s and beyond. The

Counseling Psychologist, 18(3), 436-440.

Kaplan, A. (1964). The Conduct of Inquiry. New York: Harper & Row.

Kim, K. (2003). Baccalaureate nursing students’ experiences of anxiety producing

situations in the clinical setting. Contemporary Nurse, 14(2), 145-155.

Knowles, M.S. (1980). The modern practice of adult education. New York: Cambridge,

The Adult Education Company.

132

Knowles, M. S. (1984). The adult learner: A neglected species (3rd Ed.). Houston: Gulf

Publishing.

Knowles, M.S., Holton, E.F., & Swanson, R.A. (2011). The adult learner: The definitive

classic in adult education and human resource development (7th ed.). Burlington,

MA: Butterworth-Heinemann.

Koltz, R. L., & Feit, S. S. (2012). A phenomenological study: The experience of live

supervision during a pre-practicum counseling techniques course. The Qualitative

Report, 17(40), 1-24.

Kottler, J. A. (2010). On being a therapist (4th ed.). New York, NY. Jossey Bass.

Ladany, N., Ellis, M, V., & Friedlander, M. L. (1999). The supervisory working alliance,

trainee self-efficacy, and satisfaction with supervision. Journal of Counseling &

Development, 77, 447-455.

Ladany, N. (1995). The relationship between the supervisory working alliance and

trainee’s experience of role conflict and role ambiguity. Counselor Education &

Supervision, 34(3), 220-231.

Lawson, G. (2007). Counselor wellness and impairment: A national survey. Journal of

Humanistic Counseling, Education, and Development, 46, 20–34.

Lazarus, R. S. (1999). Hope: An emotion and a vital coping resource against despair.

Social Research, 66(2), 653-678.

Lazarus, R. S. (1966). Psychological stress and the coping process. New York: McGraw-

Hill.

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer

Publishing.

133

Lehrman-Waterman, D., & Ladany, N. (2001). Development and validation of the

evaluation process within supervision inventory. Journal of Counseling

Psychology, 48 (2), 168–177.

Lincoln, Y. S. and Guba, E. G. (1986), But is it rigorous? Trustworthiness and

authenticity in naturalistic evaluation. New Directions for Program Evaluation,

1986, 73–84.

Liddle, B. J. (1986). Resistance in supervision: A response to perceived threat. Counselor

Education & Supervision, 24, 117-128.

Linde, L. (2010, May). From the president: Counseling is. . . . Counseling Today , 52(11),

p. 5.

Loganbill, C., Hardy, E., & Delworth, U. (1982). Supervision: A conceptual model.

Counseling Psychologist, 10, 3-42.

Lumadue, C. A., & Duffey, T. H. (1999). The role of graduate programs as gatekeepers:

A model for evaluating student counselor competence. Counselor Education and

Supervision, 39, 101–109.

Manning, K. (1997). Authenticity in constructivist inquiry: Methodological

considerations without prescription. Qualitative Inquiry, 3(1), 93-115.

Marquardt, M., & Waddill, D. (2010). The power of learning in action learning: A

conceptual analysis of how the five schools of adult learning theories are

incorporated within the practice of action learning. Action Learning: Research

and Practice, 1(2), 185-202.

Mauzy, E. M., & Erdman, P. (1997). Trainee perceptions of live supervision phone-ins.

The Clinical Supervisor, 15(2), 115-128.

134

Mauzy, E. M., Harris, M. B., & Trusty, J. (2001). Comparing the effects of live

supervision interventions on novice trainee anxiety and anger. The Clinical

Supervisor, 19(2), 109-122.

Merriam, S.B. (1998). Qualitative research and case study applications in education, San

Francisco, CA: Jossey-Bass.

Merriam, S.B. (2001) Andragogy and self directed learning: Pillars of adult learning

theory. In Merriam, S. B. (Eds.), The new update on adult learning theory, no.89.

San Francisco, CA: Jossey-Bass.

Merriam, S.B. (2009). Qualitative research: A guide to design and implementation. San

Francisco, CA: Jossey-Bass.

Merton, R. K. (1967). On Theoretical Sociology. New York: Free Press.

Mezirow, J. (1996). Contemporary paradigms of learning. Adult Education Quarterly,

46(3). 158-172.

Mezirow, J. (1998). On critical reflection. Adult Education Quarterly, 48(3). 185-199.

Mobley, A. K., & Myers, J. E (2010). Counselor education laboratories: Lessons from the

literature. in Mobley, A. K., & Myers, J. E. (eds.). Developing and maintaining

counselor education laboratories. Association for Counselor Education and

Supervision, Electronic Version, retrieved on, April 12, 2011, from

http://www.acesonline.net/.

Moscaritolo, L. M. (2009). Interventional strategies to decrease nursing student anxiety in

the clinical learning environment. Journal of Nursing Education, 48(1), 17-23.

Moustakas, C. (1994). Phenomenological research methods. Thousand Oaks, CA: Sage

Publishing.

135

Myers, J. E., Mobley, A. K., & Booth, C. S. (2003). Wellness of counseling students:

Practicing what we preach. Counselor Education and Supervision, 42(4), 264-

274.

Myers, J. E., & Willard, K. (2003). Integrating spirituality into counseling and counselor

training: A developmental, wellness approach. Counseling & Values, 47(2), 142-

155.

Murray-Harvey, R. (2001). How teacher education students cope with practicum

concerns. The Teacher Educator, 37(2), 117-133.

National Association of Mental Illness (NAMI), (2006). The state of public mental health

services across the nation, Electronic Version, retrieved on, October 5, 2012, from

http://www.nami.org/.

Neufeldt, S.A. (2010). Supervision strategies for the first practicum (3rd ed.). Atlanta,

GA; American Counseling Association.

Norris, F. H., & Murrell, S. A. (1988). Prior experience as a moderator of disaster impact

on anxiety symptoms in older adults. American Journal of Community

Psychology, 16(5), 655-683.

Oklin, R., & Gaughen, S. (1991). Evaluation and dismissal of students in master's level

clinical programs: Legal parameters and survey results. Counselor Education and

Supervision, 30, 276-288.

Overholster, J. C., & Fine, M. A. (1990). Defining the boundaries of professional

competence: Managing subtle cases of clinical incompetence. Professional

Psychology: Research and Practice, 21(6), 462-469.

136

Peavy, V. (1982). Reconceptualizing counsellor trainee supervision. Canadian

Counsellor, 16(3), 189-190.

Pedersen, P. (1990). The multicultural perspective as a fourth force in counseling.

Journal of Mental Health Counseling, 12, 93-95.

Pratt, D.D. (1993). AnDragogy after twenty-five years. New Directions for Adult and

Continuing Education, 57. 15-23.

Rabinowitz, F. E., Heppner, P. P., & Roehlke, H. J. (1986). Descriptive study of process

and outcome variables of supervision over time. Journal of Counseling

Psychology, 33, 292-300

Roach, L. F., & Young, M. E. (2007). Do counselor education programs promote

wellness in their students? Counselor Education and Supervision, 47(1), 29-45.

Ronnestad, M. H. & Skovholt, T. M. (2003). The journey of the counselor and therapist:

Research findings and perspectives on professional development. Journal of

Career Development, 30, 5-44.

Rosenberg, J. I., Arcinue, F., Getzelman, M. A., & Oren, C. Z. (2005). An exploratory

look at students’ experiences of problematic peers in academic professional

psychology programs. Professional Psychology: Research and Practice, 36, 665–

673.

Sanabria, S., & Freeman, L. T. (2008). Report of the aca ethics committee: 2006-2007.

Journal of Counseling and Development, 86(2), 249-252.

Schauer, A. H., Seymour, W. R., & Geen, R. G. (1985). Effects of observing and

evaluation on anxiety in beginning counselors: A social facilitation analysis.

Journal of Counseling and Development, 63, 279-286.

137

Schure, M. B., Christopher, J., & Christopher, S. (2008). Mind-body medicine and the art

of self-care: Teaching mindfulness to counseling students through yoga,

meditation, and qigong. Journal of Counseling and Development, 86, 47-56.

Schweiger, W. S., Henderson, D. A., Clawson, T. W., Collins, D. R., & Nuckolls, M. W.

(2008). Counselor preparation: Programs, faculty, trends. New York, NY: Taylor

& Francis.

Shafran, R., & Mansell, W. (2001). Perfectionism and psychopathology: A review of

research and treatment. Clinical Psychology Review, 21, 876-906.

Shenton, A. (2004). Strategies for ensuring trustworthiness in qualitative research

projects. Education for Information, 22, 63-75.

Smith, H. L., Robinson, E. H., & Young, M. E. (2007). The Relationship among

wellness, psychological distress, and social desirability of entering master's-level

counselor trainees. Counselor Education & Supervision, 47, 96-110.

Spangler G., Pekrun R., Kramer, K., & Hofmann, H. (2002). Students' emotions,

physiological reactions, and coping in academic exams. Anxiety, Stress & Coping,

15(4), 413-432.

Strauss, A. C., & Corbin, J. M. (1998) Basics of qualitative research: Techniques and

procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage

Publishing.

Steward, R. J., Breland, S., & Neil, D. M. (2001). Novice supervisees' self-evaluations

and their perceptions of supervisor style. Counselor Education and Supervision,

41, 131-141.

138

Stoltenberg, C. D. (1981). Approaching supervision from a developmental perspective:

The counselor complexity model. Journal of Counseling Psychology, 28(1), 59-

65.

Stoltenberg, C. D., & Delworth, U. (1988). Developmental models of supervision: It is

development - Response to Holloway. Professional Psychology: Research and

Practice, 19(2), 134-137.

Stoltenberg, C. D., & McNeill, B. W. (2010). IDM supervision: An integrated

developmental model for supervising counselors and therapists (3rd ed.). New

York, NY: Taylor and Francis.

Sutton, R. I., & Staw, B. M. (1995). What theory is not. Administrative Science

Quarterly, 40, 371-384.

Taylor, B., & Kroth, M. (2009). Andragogy’s transition into the future: Meta-analysis of

andragogy and its search for a measurable instrument. Journal of Adult

Education, 38(1), 1-11.

Tennen, H., Affleck, G., Armeli, S., & Carney, M. A. (2000). A daily process approach to

coping: Linking theory, research, and practice. American Psychologists, 55(6),

626–636.

Teixeira, C. R., Kusumota, L., Pereira, M. C., Braga, F. T., Gaioso, V. P., & Zamarioli,

C. M. (2014). Anxiety and performance of nursing students in regard to

assessment via clinical simulations in the classroom versus filmed assessments.

Investigación y Educación En Enfermería, 32(2), 270-279.

139

Trepal, H. C., Bailie, J., & Leeth, C. (2010). Critical incidents in practicum supervision:

Supervisees' perspectives. Journal of Professional Counseling: Practice, Theory,

& Research, 38(1), 28-40.

Wester, K. L. (2010). Counseling laboratories and entry-level students: Pre-practicum

and practicum experiences in an on-campus practicum. In Mobley, A. K. &

Myers, J. E. (Eds.), Developing and maintaining counselor education laboratories

(2nd ed.). (pp. 202-220). Retrieved from http://www.acesonline.net/wp-

content/uploads/2011/08/mobley_myers.pdf

Wiggins, J., & Westlander, D. (1979). Personality characteristics of counselors rated as

effective or ineffective. Journal of Vocational Behavior, 15, 175-185.

Williams, E. N., Polster, D., Grizzard, M. B., Rockenbaugh, J., & Judge, A. (2003). What

happens when therapists feel bored or anxious? A qualitative study of distracting

self-awareness and therapists' management strategies. Journal of Contemporary

Psychotherapy, 33(1), 5-19.

Wong, Y. S. (1997). Live supervision in family therapy. The Clinical Supervisor, 15(1),

145-157.

Woodward, V., & Lin, Y. (1999). Designing a pre-practicum for counselor education

programs. Counselor Education & Supervision, 39(2), 134-141.

Woodside, M., Oberman, A. H., Cole, K. G., & Carruth, E. K. (2007). Learning to be a

counselor: A prepracticum point of view. Counselor Education & Supervision,

47(1), 14-28.

Worthen, V., & McNeill, B. W. (1996). A phenomenological investigation of “good”

supervision events. Journal of Counseling Psychology, 43(1), 25-34.

140

Worthington, E. L., & Roehlke, H. J. (1979). Effective supervision as perceived by

beginning counselors-in-training. Journal of Counseling Psychology, 26, 64-73.

Yager, G. A., & Beck, T. D. (1985). Beginning practicum: It only hurt until I laughed!

Counselor Education & Supervision, 24, 149-158.

Yager, G. G., & Tovar-Blank, Z. G. (2007). Wellness and counselor education. Journal

of Humanistic Counseling, Education, and Development, 46(2), 142-153.

Young, M. E. (2009). Learning the art of helping: Building blocks and techniques (4th

ed.). Pearson Education; Upper Saddle River, New Jersey.

Zhou, X., Zhu, H., Zhang, B., & Cai, T. (2013). Perceived social support as moderator of

perfectionism, depression, and anxiety in college students. Social Behavior &

Personality, 41(7), 1141-1152.

APPENDIX A

Institutional Review Board Approval

141

APPENDIX B

Informed Consent (Original)

143

APPENDIX C

Informed Consent (Modified)

145

APPENDIX D

Demographic Questionnaire

147

Demographic Questionnaire

Please answer the following about yourself. Again, I will be the only person who

will have access to your identity. Providing the following information allows me to

contact you during the study. The five-digit code you create below will be attached to all

the information gathered from you during this study.

Please print your full name:

Phone Number: Is it ok to leave a message?

Email Address:

Gender: Date of Birth:

What is your program emphasis area? _____: Mental Health Counseling

_____: Couple’s and Family Counseling

_____: School Counseling

_____: Other, ________________________

How many total semesters have you been in your masters program?

Please create a five-digit code to be associated with the data collected from you. Please

do not use your birthday, or any other set of numbers that can be associated with you.

Five Digit Code:

Thank you for your participation.

APPENDIX E

Initial Interview Question Guide

149

Initial Interview Question Guide

This interview takes place during the first three weeks of practicum. Follow up

questions and probes involved deepening the student’s descriptions of their experience of

anxiety and coping in practicum. These questions are based on the constructs of the

counselor developmental model.

1. What had you heard about practicum prior to the start of the course?

2. Describe your practicum experience thus far.

3. Describe your thoughts and feelings about seeing your first client. Possible follow up:

In what way, if any, did your anticipation match reality?

4. Describe some of the feedback you have received in practicum. How does this

feedback fit with your perception of your performance? What would you add or

delete from the feedback?

5. What TV show, book, or song would describe your practicum experience thus far?

6. Is there anything else about practicum that you would like to talk about that we

haven’t touched on?

APPENDIX F

Four Guided Journal Prompts

151

Four Guided Journal Prompts

The following are the guided journal prompts that were sent to participants

between the third and thirteenth weeks of practicum. Each guided journal prompt was

sent to the participants through email and the responses were emailed back to me. Each

email began with the following text regarding instructions:

Hello!

Thank you for participating in this research study. The following is the journal

prompt for you to write about for this week. Please take some time to respond in a

maximum of eight paragraphs. Once you have completed this journal exercise, please

email your response back to me as soon as possible.

Again, thank you.

Ernie Zullo, MA LPC

Doctoral Candidate

Counselor Education and Supervision

Guided Journal Entry One (the fourth week of practicum).

Describe four things that have surprised you about your experiences so far in

practicum. These might involve individual or group supervision, being observed live

through the one-way mirror, interactions with clients, or anything else specific to your

practicum so far this semester.

Guided Journal Entry Two (the seventh week of practicum).

Describe the overall feedback you have received so far in practicum. What feedback

surprised you? What feedback was difficult to hear? Did this feedback come from a

peer or a supervisor? How has your feedback changed over time?

Guided Journal Entry Three (the tenth week of practicum).

Briefly describe the self-care plan you made for yourself at the beginning of your

program, or at the beginning of practicum. What helped and what wasn’t effective

this semester? What did you change about your plan as the semester progressed?

Guided Journal Entry Four (the thirteenth week of practicum).

Describe how participating in this research study impacted your experience in

practicum this semester. What was easiest to discuss or describe? What was difficult?

What would you liked to have discussed that you did not?

APPENDIX G

Final Interview Question Guide

153

Final Interview Question Guide

This interview takes place during the last three weeks of practicum. Because this

interview takes place as the practicum is coming to an end, these questions are more

direct regarding the experience of stress, anxiety, and coping than previous research

activities. Follow up questions and probes will still involve deepening the student’s

descriptions of their experience of anxiety and coping in practicum.

1. As you look back on your practicum experience, what stands out?

2. What was your internal dialogue while seeing your first client? What is your internal

dialogue now as you finish practicum?

3. What if any conflicts did you have with others in practicum? How were these

conflicts resolved?

4. Describe the best moment in practicum. Describe your worst moment in practicum.

5. Describe the process of receiving and giving feedback.

6. Describe your experiences with the live supervision environment and process.

7. How did you cope with the stress and anxiety of practicum? Follow up: Were these

new behaviors or strategies? To what degree did these behaviors or strategies work?

8. What advice would you give the next semester's practicum students?

9. Is there anything else about practicum that you would like to talk about that we

haven’t touched on?